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Gastroesophageal Reflux in Infants

Medically reviewed by Last updated on Jan 5, 2023.

What is gastroesophageal reflux?

Gastroesophageal reflux (GER) occurs when the lower muscle (sphincter) of your baby's esophagus does not close properly. The sphincter normally opens to let food into the stomach. It then closes to keep food and stomach acid in the stomach. If the sphincter is not fully developed or does not close properly, food and stomach acid may back up (reflux) into the esophagus. GER becomes gastroesophageal reflux disease (GERD) when symptoms prevent your baby from eating, or they last more than 12 months. GERD is a long-term condition that develops when the acid has irritated your baby's esophagus.

What increases my baby's risk for GER?

  • Neurological disorders such as cerebral palsy
  • Premature birth
  • Parents with GERD
  • Hiatal hernia
  • Exposure to secondhand smoke

What are the signs and symptoms of GER?

The most common symptom is frequent spitting up or vomiting after feedings. Symptoms may be worse if you lay your baby down to sleep or you put him or her in a car seat after a feeding. Your baby may also have any of the following:

  • Irritability or constant crying after eating
  • Wet burps or hiccups
  • Wheezing
  • Dry cough or hoarseness
  • Gagging or choking while eating
  • Poor feeding and growth
  • Back arching during feedings

How is GER diagnosed?

Your baby's healthcare provider will examine your baby. He or she will ask about your baby's symptoms and when they started. Tell the healthcare provider about your baby's feeding habits and any medical conditions. Your baby may need a MII-pH monitoring test. The MII shows movement of solids, liquids, and air in the esophagus. It will show if the movement is forward to the stomach, or backward into the esophagus. The pH is also tested to see if the liquid is acidic.

How is GER treated?

The goal of treatment is to relieve your baby's symptoms and prevent damage to his or her esophagus. Treatment also helps promote healthy weight gain and growth. Your baby may need any of the following:

  • Medicines help decrease stomach acid and help your baby's lower esophageal sphincter and stomach contract (tighten) more.
  • Surgery may be needed if your baby has GERD and other treatments do not work. During surgery, the upper part of the stomach is wrapped around the esophageal sphincter. This will help strengthen the sphincter and prevent reflux.

What can I do to help manage my baby's GER?

  • Smaller, more frequent feedings may be recommended by your baby's healthcare provider.
  • Practice safe sleeping techniques to decrease risk of sudden infant death syndrome.
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  • Keep a diary of your baby's symptoms. Bring the diary to visits with your baby's healthcare provider. The diary may help the provider plan the best treatment for him or her.
  • Keep your baby away from cigarette smoke. Do not smoke or allow others to smoke around your baby.

Call your local emergency number (911 in the US) if:

  • Your baby suddenly stops breathing, begins choking, or his or her body becomes stiff or limp.

When should I call my baby's doctor?

  • Your baby has forceful vomiting.
  • Your baby's vomit is green or yellow, or has blood in it.
  • Your baby has blood in his or her bowel movements.
  • Your baby suddenly has trouble breathing or wheezes.
  • Your baby's stomach is swollen.
  • Your baby becomes more irritable or fussy and does not want to eat.
  • Your baby becomes weak and urinates less than usual.
  • Your baby is losing weight.
  • You have questions or concerns about your baby's condition or care.

Care Agreement

You have the right to help plan your baby's care. Learn about your baby's health condition and how it may be treated. Discuss treatment options with your baby's healthcare providers to decide what care you want for your baby. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.