Infant Reflux and Baby Formula

Signs that spitting up might be more than a mess

Medically, it shouldn't hurt to frequently change your infant's formula, as long as you stick with one that is iron fortified. Some infants do have minor problems with diarrhea or constipation or have feeding problems as they adjust to being on a new formula, though.

Baby drinking from a bottle
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The Happy Spitter

If your infant is simply spitting up and has gastroesophageal reflux, but is gaining weight well and has no other symptoms, you may not need to ​change their formula. Experts estimate that more than half of young infants spit up at least one or more times a day. And the scary part is that amount of formula often looks like much more than it actually is when they do.

At this age, infants normally gain about 1 1/2 to 2 pounds a month. If your baby is gaining weight, that is a good sign that his spitting up isn't causing a problem for him. Infants like this who spit up with no other signs or symptoms are often called "happy spitters." It is often recommended that you simply wait it out until they stop spitting up as they get older.

Problem Reflux Symptoms

In addition to difficulty gaining weight or possibly losing weight, signs that reflux is causing a problem include that an infant:

  • Is often fussy or irritable
  • Frequently chokes or has wheezing or 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, then they may have gastroesophageal reflux disease or GERD and need further evaluation and treatment.

Changing Formula for Reflux

Unless your baby has other symptoms of a formula intolerance, like a lot of gas, diarrhea, bloody stools, in addition to vomiting or spitting up and being fussy, then changing formula isn't usually helpful.

If you are going to try a different formula, then a hypoallergenic formula, like Alimentum or Nutramigen, may be the best choice, since some studies have shown improvement in infants who just had vomited when changed to this type of formula.

Enfamil AR or Similac for Spit-Up are specialty formulas that can be helpful for infants that do have reflux, and that may be an option if your child doesn't have a milk protein allergy or lactose intolerance.

Treating Reflux

For infants with reflux and GERD, treatments can include:

  • Lifestyle changes: These include thickening your infant's formula with rice cereal (you may have to enlarge the hole of the nipple), positioning changes (keep baby upright for at least 30 minutes), and feeding smaller amounts more frequently, instead of larger, less frequent feedings.
  • Reflux medications: These include acid reducers, such as Nexium, Prevacid, and Zantac. Note that infants who are "happy spitters," have good weight gain, and don't have excessive crying, or feeding or respiratory problems usually don't need to be treated with medications for their reflux.

April 1, 2020 Update: The Food and Drug Administration (FDA) announced the recall of all medications containing the ingredient ranitidine, known by the brand name Zantac.

The FDA also advised against taking OTC forms of ranitidine, and for patients taking prescription ranitidine to speak with their healthcare provider about other treatment options before stopping medication. For more information, visit the FDA site.

It is also often recommended that you not re-feed your baby immediately after the child spits up, which can lead to overfeeding and more spitting up.

The diagnosis of reflux is usually made by the characteristic symptoms. Testing, such as with an upper GI is sometimes done, but it is often done more to make sure that an infant doesn't have another reason to be vomiting, like an obstruction, instead of confirming the diagnosis of reflux. Other tests can include a pH probe, although that is an invasive test.

For infants with persistent symptoms, especially if they aren't gaining weight well, a pediatric gastroenterologist can be helpful. Rarely, even after optimal medical management, surgical treatment with a Nissen fundoplication ends up being the only treatment option.

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  1. 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