Digestive Health Heartburn Acid Reflux in Children Infant Reflux and Baby Formula Signs that spitting up might be more than a mess By Vincent Iannelli, MD Vincent Iannelli, MD Facebook Vincent Iannelli, MD, is a board-certified pediatrician and fellow of the American Academy of Pediatrics. Dr. Iannelli has cared for children for more than 20 years. Learn about our editorial process Updated on July 18, 2022 Medically reviewed by Jay N. Yepuri, MD, MS Medically reviewed by Jay N. Yepuri, MD, MS Facebook LinkedIn Twitter Jay Yepuri, MD, MS, is a board-certified gastroenterologist and a practicing partner at Digestive Health Associates of Texas (DHAT). Learn about our Medical Expert Board Fact checked by Angela Underwood Fact checked by Angela Underwood LinkedIn Angela Underwood's extensive local, state, and federal healthcare and environmental news coverage includes 911 first-responder compensation policy to the Ciba-Geigy water contamination case in Toms River, NJ. Her additional health-related coverage includes death and dying, skin care, and autism spectrum disorder. Learn about our editorial process Print Table of Contents View All Table of Contents The Happy Spitter Reflux Symptoms Changing Formula Diagnosis Treatment Frequently Asked Questions If your baby has acid reflux, you may wonder if a different formula would prevent it. Spitting up is normal, but reflux is something you want to head off. Medically speaking, switching formulas shouldn't hurt your baby. Some infants do have diarrhea, constipation, or feeding problems as they adjust to a new formula. But a change may not be necessary. This article will help you decide whether there's a problem that needs to be addressed, how to choose a new formula, and what other options you have for treating acid reflux in your baby. Tetra Images / Brand X Pictures / Getty Images The Happy Spitter If your baby has gastroesophageal reflux and is spitting up, but they're gaining weight and don't have other symptoms, you may not need to change their formula. Experts estimate 50% of infants younger than 3 months spit up at least one time a day. You may wonder whether your little one is keeping enough of their food down. Try to keep in mind that the amount they spit up often looks like much more than it actually is. In the first few months, babies normally gain between about 1.5 and 2 pounds a month. If your child is gaining weight, that's a good sign that their spitting up isn't a problem. Babies who spit up but don't have other symptoms are often called "happy spitters." Experts often recommend that you simply wait and see if they stop spitting up as they get older. Problem Reflux Symptoms Signs that reflux is causing a problem include a baby who: Isn't gaining weight or is losing weightIs often fussy or irritableFrequently chokes, wheezes, or has difficulty breathingOften refuses to eat (dysphagia)Arches their back during or right after feedingsHas a chronic coughHas a hoarse voice or cry If a child is spitting up and has any of the symptoms listed above, they may have gastroesophageal reflux disease (GERD). You should get them to a pediatrician for diagnosis and treatment. Changing Formula for Reflux Unless your baby has other symptoms of a formula intolerance—like a lot of gas, diarrhea, or bloody stools in addition to vomiting or spitting up and being fussy—then changing formula isn't usually helpful. If you're going to try a different formula, then a hypoallergenic formula, like Alimentum or Nutramigen, may be the best choice. Some studies have shown less vomiting in babies who changed to this type of formula. Enfamil AR or Similac for Spit-Up are specialty formulas that can be helpful for babies with reflux. They may be an option if your child doesn't have a milk protein allergy or lactose intolerance. Eczema Triggers and Allergic Reactions in Children Diagnosing Reflux Healthcare providers generally diagnose reflux based on the characteristic symptoms. If they suspect your baby has an obstruction or something else causing the vomiting, they may order X-rays called an upper gastrointestinal (GI) series. Another possible test is a pH probe, but it's an invasive test and isn't done often. If your baby has persistent symptoms, especially with low weight gain, you may be sent to a pediatric gastroenterologist. In rare and serious cases, a surgical procedure may be an option. Treating Reflux For babies with reflux and GERD, treatments can include lifestyle changes and reflux medications. Lifestyle changes include: Thickening formula with rice cereal (you may have to enlarge the hole of the nipple)Positioning changes such as keeping them upright for at least 30 minutes after eatingFeeding smaller amounts more frequently instead of larger, less frequent feedings It is also often recommended that you not re-feed your baby immediately after they spit up, which can lead to overfeeding and more spitting up. Reflux medications include acid reducers such as: Nexium (esomeprazole) Prevacid (lansoprazole) Pepcid/Zantac (famotidine) Your baby may not need reflux medication if they: Are happy spittersHave good weight gainDon't have excessive cryingDon't have feeding or respiratory problems Treating Reflux in Babies and Children In 2020, the Food and Drug Administration (FDA) announced the recall of all medications containing ranitidine, formerly known by the brand name Zantac. The FDA said to stop taking ranitidine and to talk to your healthcare provider about alternatives. Since then, Zantac has come back onto the market with a different ingredient. Summary If your baby spits up a lot, they may have acid reflux or GERD. If they're gaining weight normally and don't have other symptoms, it may not be a problem. If they're not gaining weight, are irritable, or have other GERD symptoms, they may need to be treated. Changing formulas can sometimes help, especially if you go to a hypoallergenic product or a formula designed for babies with reflux. GERD is often diagnosed based on symptoms alone. Other tests may help rule out other causes of symptoms. Treatment includes simple changes to your feeding routine (such as positioning changes or feeding smaller amounts) and acid-reducing medications. Frequently Asked Questions When should you be concerned about infant reflux? Most babies spit up from time to time. Reflux is a problem if the baby is having difficulty gaining weight or is losing weight. Other problems to watch for include choking or wheezing, a hoarse voice or cry, difficulty breathing, or refusal to eat. What are signs of a formula intolerance? Some babies can have digestive problems from formula, a condition known as formula intolerance. This makes them spit up a lot in addition to other symptoms, like excessive gas, diarrhea, bloody stools, and vomiting. Can Similac for Spit Up or Enfamil AR help calm reflux? Yes. As long as the baby does not have a milk protein allergy or lactose intolerance, specialty formulas can help to reduce the frequency and amount of reflux. Treating Reflux in Infants 9 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. UpToDate. Patient education: Acid reflux (gastroesophageal reflux) in infants (Beyond the Basics). Nemours KidsHealth. How much will my baby grow? Czinn SJ, Blanchard S. Gastroesophageal reflux disease in neonates and infants : when and how to treat. Paediatr Drugs. 2013;15(1):19-27. doi:10.1007/s40272-012-0004-2 National Institutes of Health, U.S. National Library of Medicine: MedlinePlus. Reflux in infants. Rosen R, Vandenplas Y, Singendonk M, et al. Pediatric gastroesophageal reflux clinical practice guidelines: Joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr. 2018;66(3):516-554. doi:10.1097/MPG.0000000000001889 Ramirez-Farias C, Baggs GE, Marriage BJ. Growth, tolerance, and compliance of infants fed an extensively hydrolyzed infant formula with added 2'-FL fucosyllactose (2'-FL) human milk oligosaccharide. Nutrients. 2021;13(1):186. doi:10.3390/nu13010186 Pados BF, Feaster V. Effect of formula type and preparation on international dysphagia diet standardisation initiative thickness level and milk flow rates from bottle teats. Am J Speech Lang Pathol. 2021;30(1):260-265. doi:10.1044/2020_ajslp-20-00272 National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. Diagnosis of GER & GERD in infants. Yoo BG, Yang HK, Lee YJ, Byun SY, Kim HY, Park JH. Fundoplication in neonates and infants with primary gastroesophageal reflux. Pediatric Gastroenterology, Hepatology & Nutrition. 2014;17(2):93-97. doi:10.5223/pghn.2014.17.2.93 By Vincent Iannelli, MD Vincent Iannelli, MD, is a board-certified pediatrician and fellow of the American Academy of Pediatrics. Dr. Iannelli has cared for children for more than 20 years. See Our Editorial Process Meet Our Medical Expert Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit