Preventing Infant Acid Reflux, or GERD

Many babies have problems with spitting up that don't require treatment. In these babies, referred to as "happy spitters," symptoms usually disappear after six to eight months. For some infants, however, symptoms are a sign of something more serious, such as gastroesophageal reflux disease (GERD), and they need medical attention.

This article explores what you can do to ease your baby's symptoms, whether your infant has harmless spitting or needs medical treatment for reflux.

Prevention

Your pediatrician will be able to tell whether your baby's symptoms are normal spitting up or if the child instead has a chronic medical condition that needs treatment. Your healthcare provider will then be able to give you advice on the best treatment for your baby.

Reflux can occur when the sphincter muscle at the low end of the esophagus (the tube that takes food from the mouth to the stomach) relaxes at the wrong time. This allows stomach acid to back up into the esophagus. If your baby is experiencing acid reflux, the following tips may help to reduce your baby's discomfort and episodes of spitting up.

Hold Baby Upright

Holding infants in an upright position both during feedings and for at least 30 minutes afterward will help to reduce the amount of gastric reflux. While holding your baby, however, make sure the child's abdomen isn't compressed, which could worsen reflux.

Nighttime Sleep Position

Even though the prone (on the stomach) sleeping position was recommended for babies with reflux in the past, this is no longer the case. In infants with GERD—and in all infants—the risk of SIDS (sudden infant death syndrome) generally outweighs the potential benefits of prone sleeping.

Some healthcare providers may recommend elevating the head of your baby's crib so that the baby is sleeping on an incline in order to allow gravity to help keep her stomach contents where they belong. While studies have not looked specifically at babies sleeping at an incline in their cribs, studies of babies sleeping at an incline in infant car seats have found an association between this practice and an increased risk of SIDS.

It is very important to talk with your infant's doctor before undertaking any changes in sleeping positions.

Try Smaller, More Frequent Feedings

Feedings every two to three hours, while your infant is awake, will often reduce the occurrence of gastric reflux. Overfeeding can increase abdominal pressure, which can lead to gastric reflux. If you are bottle-feeding, using nipples with smaller holes may also help by reducing the amount of air the baby takes in and, therefore, how distended her abdomen becomes. A distended abdomen can increase reflux.

Rice Cereal May Help

If your child has begun solid foods (usually recommended after 4 months of age and not sooner) rice cereal may help to reduce the amount an infant will regurgitate. Start with one teaspoon of rice cereal to each ounce of formula. If your baby is breastfed, try pumping and then adding rice cereal to the breast milk.

Diet Modifications for Mothers Who Breastfeed

Certain foods—such as caffeine, chocolate, and garlic—can promote reflux. So, if you breastfeed your infant, you should consider cutting these foods out of your diet. Some breastfeeding parents have also found that eliminating milk or eggs from their diet helps, as well.

Other factors may contribute to spitting up in babies who breastfeed. If you have a strong let-down reflex (the hormonal response from your body to provide milk), your baby may choke when latching on.

If this is common for you, consider pumping for a moment before breastfeeding your infant. If you are engorged when you begin feeding, your baby may have difficulty latching on and may swallow more air. Again, pumping for a short while before feedings may be helpful.

Quiet Time and Feedings

Just as adults can develop heartburn and reflux if they are feeling anxious, babies who are anxious or overstimulated may also spit up more. Make feeding time more enjoyable by eliminating loud noises and distractions and dimming the lights. Likewise, avoid vigorous activity and active play for up to 30 minutes after a feeding.

Infant Seats and Car Seats

The way your infant is positioned in a car seat can cause regurgitation to increase. If your infant slouches, abdominal compression can result, increasing the risk of reflux. Using simple supports to keep your infant upright will prevent this.

Burping the Infant

Burping your infant several times during the feeding (after every ounce or two) will help minimize gastric pressure and the reflux it can cause. Waiting to burp your infant until after the baby has a full stomach can increase the chances of regurgitation.

Medications

Your healthcare provider may recommend medications if your baby has severe reflux symptoms such as choking and coughing. Studies to date have shown little benefit on the whole with this practice, though it may be helpful for some babies. Reducing stomach acid may also increase the risk of infection (since acid can kill off harmful bacteria), so these drugs should only be used with careful guidance from your healthcare provider.

Surgery

On occasion, surgery (open Nissan fundoplication, or ONF) may be needed for babies with severe reflux. If you are considering this procedure, make sure to talk to a pediatric surgeon who has performed many of these procedures and can tell you what you can expect with the surgery.

Other Things You Can Do

Avoid tight elastic around your baby's waist and keep diapers loose. Also, don't give your infant caffeinated beverages, orange juice, or other citrus juices.

A Word From Verywell

Reflux in babies can be very frustrating, and there is rarely one step alone that helps. In addition, every baby is different, and some of these tips may work better with some than with others.

Fortunately, reflux often improves as a baby gets older, and for those in which it persists, there are a variety of treatment options. Please remember that if you have any questions about your baby's health—no matter how seemingly small—it’s always a good idea to consult with your pediatrician.