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 February 23, 2022 Medically reviewed Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Jay N. Yepuri, MD, MS Medically reviewed by Jay N. Yepuri, MD, MS Facebook LinkedIn Twitter Jay Yepuri, MD, MS, is board-certified in gastroenterology. He is a partner with Digestive Health Associates of Texas and a medical director at Texas Health Harris Methodist HEB Hospital. Learn about our Medical Expert Board Fact checked Verywell Health content is rigorously reviewed by a team of qualified and experienced fact checkers. Fact checkers review articles for factual accuracy, relevance, and timeliness. We rely on the most current and reputable sources, which are cited in the text and listed at the bottom of each article. Content is fact checked after it has been edited and before publication. Learn more. 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 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. Tetra Images/Brand X Pictures/Getty Images 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 50% of 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 irritableFrequently chokes or has wheezing or 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, 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. 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. Babies with formula intolerance 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. Formulas made for babies with reflux include Enfamil AR or Similac for Spit-Up. Treatment Options for Acid Reflux in Infants Was this page helpful? Thanks for your feedback! Get nutrition tips and advice to make healthy eating easier. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit 7 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 Foundation/Kidshealth.org. How Much Will My Baby Grow? 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 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. National Institute of Health. 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