Digestive Health Heartburn Acid Reflux in Children Preventing Infant Acid Reflux or GERD By Sharon Gillson Sharon Gillson is a writer living with and covering GERD and other digestive issues. Learn about our editorial process Sharon Gillson Medically reviewed by Medically reviewed by Jonathan B. Jassey, DO on March 18, 2020 facebook Jonathan B. Jassey, DO, is board-certified in pediatrics. He has been in private practice at Bellmore Merrick Medical in New York since 2007 and is the co-author of "The Newborn Sleep Book." Learn about our Medical Review Board Jonathan B. Jassey, DO Updated on April 17, 2020 Print Table of Contents View All Table of Contents Prevention Holding Sleeping Adjust Feeding Rice Cereal Breastfeeding Quiet Time Infant Seats Burping Medications Surgery More Tips Many babies have spitting up problems 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. Along with recommendations from your doctor, what can you do to ease your baby's symptoms whether she has harmless spitting or needs medical treatment for reflux? Sally Anscombe/Getty Images Prevention Your pediatrician will be able to distinguish whether your baby's symptoms are normal "spitting up" or if she instead has a chronic medical condition which needs treatment. She will then be able to give you advice on the best treatment for your baby. If your baby is experiencing reflux, the following tips may help to reduce her discomfort, and hopefully, spitting up. Hold Baby Upright Holding infants in an upright position both during feedings and for at least 30 minutes after feedings will help to reduce the amount of gastric reflux. While holding your baby, however, make sure her 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 recommended. In infants with GERD, the risk of SIDS generally outweighs the potential benefits of prone sleeping. Having an infant sleep on her stomach is only considered in very unusual cases in which the risk of death from complications of GERD outweighs the potential increased risk of SIDS. Always place your baby to sleep on her back unless your pediatrician has told you otherwise. Some physicians may recommend elevating the head of your baby's crib so that she 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 a car seat find that this practice is associated with 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. 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 (which, in turn, increases 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. Eliminating milk or eggs from their diet has also been helpful for some breastfeeding mothers. Other factors may contribute to spitting up in babies who breastfeed. If you have strong let-down reflex, your baby may choke when latching on. If this occurs, some mothers pump for a moment before breastfeeding. 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 over, it causes abdominal compression, 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 she has a full stomach can increase the chances of regurgitation. Medications Your doctor 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 physician. 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 which helps. In addition, every baby is different, and some of these tips may work better than 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. 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 Article 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. Adamiak T, Plati KF. Pediatric Esophageal Disorders: Diagnosis and Treatment of Reflux and Eosinophilic Esophagitis. Pediatr Rev. 2018;39(8):392-402. doi:10.1542/pir.2017-0266 Baird DC, Harker DJ, Karmes AS. Diagnosis and Treatment of Gastroesophageal Reflux in Infants and Children. Am Fam Physician. 2015;92(8):705-14. Adams SM, Ward CE, Garcia KL. Sudden infant death syndrome. Am Fam Physician. 2015;91(11):778-83. United States Consumer Product Safety Commission. Supplemental Notice of Proposed Rulemaking for Infant Sleep Products. https://www.cpsc.gov/s3fs-public/SupplementalNoticeofProposedRulemakingforInfantSleepProducts_10_16_2019.pdf. October 16, 2019. El-mahdy MA, Mansoor FA, Jadcherla SR. Pharmacological management of gastroesophageal reflux disease in infants: current opinions. Curr Opin Pharmacol. 2017;37:112-117. doi:10.1016/j.coph.2017.10.013 Additional Reading Chen, P., Soto-Ramirez, N., Zhang, H., and W. Karmaus. Association Between Infant Feeding Modes and Gastroesophageal Reflux: A Repeated Measurement Analysis of the Infant Feeding Practices Study II. Journal of Human Lactation. 2017. 33(2):267-277. Kliegman, Robert M., Bonita Stanton, St Geme III Joseph W., Nina Felice. Schor, Richard E. Behrman, and Waldo E. Nelson. Nelson Textbook of Pediatrics. 20th Edition. Philadelphia, PA: Elsevier, 2015. Print. Lightdale, J., Gremse, D., Section on Gastroenterology, Hepatology, and Nutrition. Gastroesophageal Reflux: Management Guidance for the Pediatrician. Pediatrics. 2013. 131(5):e1684-95.