Infant Reflux and Baby Formula

Signs that spitting up might be more than a mess

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.

Baby drinking from a bottle

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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 weight
  • Is often fussy or irritable
  • Frequently chokes, wheezes, or has difficulty breathing
  • Often refuses to eat (dysphagia)
  • Arches their back during or right after feedings
  • Has a chronic cough
  • Has 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.

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 eating
  • Feeding 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:

Your baby may not need reflux medication if they:

  • Are happy spitters
  • Have good weight gain
  • Don't have excessive crying
  • Don't have feeding or respiratory problems

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.

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.
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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.