Reflux in Babies and Toddlers

Gastroesophageal reflux, or GER, is a common condition affecting about half of young infants. It peaks between 3 and 4 months and usually resolves by 12 months of age. Babies that have GER regurgitate, or spit up, shortly after eating. This happens when stomach contents return up the esophagus and into and out of the mouth.

Cause of GER in Infants

The cause of GER is an immature digestive system. The muscle that separates the stomach from the esophagus can be underdeveloped in some babies, allowing undigested stomach content to rise up into the esophagus. This muscle matures between 6 and 12 months of age, so only about 10% of babies have GER after age 12 to 14 months.

In most cases, reflux is mild and normal. If you have a happy baby who is eating and growing normally, there’s no reason to be concerned. Severe GER, however, can indicate gastroesophageal reflux disease, or GERD, or gastrointestinal obstruction, which are rare but more serious conditions. Speak with your pediatrician if your baby is not gaining weight, spits up large amounts, vomits forcefully (projectile vomiting), spits up fluid that is green or yellow or contains blood, repeatedly refuses food, has difficulty breathing after vomiting or shows signs of dehydration (such as having dry diapers or extreme fussiness).

Preventing GER

Here are some tips to prevent reflux in your baby:

• Feed small, frequent meals.
• Get rid of excess gas by burping your baby more frequently not only after, but during feeding.
• Keep your baby upright at least 30 minutes after feeding. This may result in less reflux than when babies recline in an infant seat.
• Continue to breastfeed. For breastfeeding moms, a 2 to 4 week trial of avoiding milk and other dairy products as well as eggs may be worthwhile, because sometimes GER actually reflects symptoms of an infant’s food sensitivity. Restricting these or other foods in the diet of a breastfeeding mother is not recommended as a way to prevent food allergies in her baby. But if an allergy has developed, changing the mother’s diet can help.
• If you use infant formula, talk with your baby’s doctor about switching to a thickened formula or one with protein that is already broken down or “predigested."

A small percentage of infants are unable to handle proteins found in milk or soy formulas. Consult with your pediatrician about alternative formulas. To pinpoint trigger foods, keep a journal of all foods eaten and symptoms experienced, and add only one new food at a time.

Registered dietitian nutritionist can help you analyze a food journal and instruct you on creating the best eating plan for your baby.

Long-Term Prognosis for Infants with GER

Most babies grow out of reflux as their gastrointestinal track matures. Check with the baby’s doctor to monitor weight and ensure your baby is staying hydrated and not experiencing an obstruction of the gastrointestinal tract.

However, if symptoms continue beyond the first year of age, especially if your toddler is showing signs of poor growth or problems with breathing, consult your baby’s health care provider. Babies who frequently spit up may be more likely to develop GERD as older children.