Infant Reflux (GER)

What is Infant Reflux?

Infant reflux or gastrointestinal reflux (GER) can cause babies to spit up many times each day. GER is not to be confused with GERD (gastrointestinal reflux disease). GER, or infant reflux, is a common occurrence before the age of 18 months. Unless it is excessive, it is usually harmless.

A wet burp can happen when the baby burps and small amounts of food come up. However, burps do not always occur when spitting up. Spit-up can come up whenever the stomach contains food. It usually happens because the lower esophageal sphincter is not always fully developed in babies that are under a year and a half. Prone positioning during feedings can cause food to back up because the sphincter is not yet effective.

Small amounts of food simply go the wrong way. Gastrointestinal reflux can also be caused by secondhand smoke, caffeine and/or nicotine in breastmilk or a food allergy. It is rarely caused by a physical abnormality, a digestive blockage or another serious or life-threatening condition. The vast majority of babies outgrow it.

What are the Symptoms of Infant Reflux?

Professional medical care should be sought when the following symptoms occur.

Symptoms include

  • Weight loss or failure to gain weight
  • Projectile vomiting
  • Spitting up yellow or green
  • Spit-up containing blood or dark brown granules
  • Lack of appetite
  • Blood in the stool
  • Breathing problems
  • Lingering cough
  • Spitting up that starts at age six months or more
  • Irritability after feedings

Infant Reflux Causes

The cause of infant reflux – also known as gastroesophageal reflux (GER) – isn’t fully known. However, certain factors can result in infant reflux, including hiatal hernia, immature lower esophageal sphincter, overfeeding, gastroparesis (delayed emptying of a baby’s stomach), and a short or narrow esophagus.

A baby’s diet, or a breastfeeding mother’s diet, is also a factor in determining whether that baby develops infant reflux. Babies can also develop infant reflux by simply being born prematurely, being on a mostly liquid diet, and lying flat the majority of the time – most of which is inescapable.

Sometimes infant reflux can be caused by a more serious underlying condition, such as eosinophilic esophagitis, pyloric stenosis, GERD (gastroesophageal reflux disease), and pyloric stenosis.

How is Infant Reflux Treated?

When a baby is thriving and seemingly healthy, infant reflux (GER) does not require special care or medication. The need for treatment depends on the cause and severity of gastrointestinal reflux and the accompanying symptoms.

Treatment includes

  • Smaller and more frequent feedings
  • Burping the baby more often during feedings
  • Keeping the baby in an upright position for at least 20 minutes after meals
  • The elimination of common food allergens, if breastfeeding
  • Changing to a more easily digestible formula
  • Changing bottle nipples to avoid air swallowing
  • Light and gradual thickening of formula or breast milk with rice cereal
  • Acid blocking oral medication
  • Surgery to tighten the lower gastrointestinal sphincter

Infant Reflux Prevention

Preventing infant reflux is as simple as making a few simple changes in how you care for your baby. For instance, holding your baby upright when feeding him and for at least a half hour afterwards can help prevent infant reflux. You can also feed your baby rice cereal (after at least 4 months of age), burp your baby a few times during each feeding (every 1 to 2 ounces of milk or after nursing from each breast), give your baby less milk and more frequently, and keep your baby calm – as opposed to anxious or overly excited. When babies are more at ease, they’re less likely to get heartburn and infant reflux.

Rice cereal can be added to your baby’s bottle of breast milk or formula, but make sure not to overfeed your baby and also be sure that the mixture isn’t too thick to drink. If it becomes too thick, simply cut a small “x” in the nipple to make more room for milk flow, or go up one nipple size.