Tips for Preventing Infant Acid Reflux or GERD

Many babies have spitting up problems that don't require treatment. Referred to as "happy spitters," these symptoms usually disappear after six to eight months. For some infants, however, their symptoms are a sign of something more serious, such as gastroesophageal refux 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?

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.

Holding infants in an upright position both during feedings, 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.

Even though the prone (on the stomach) sleeping position was recommended for babies with reflux in the past, this is no longer recommended. In fact, the evidence is quite strong that prone sleeping should be avoided if at all possible.

In infants with GERD, the risk of SIDS generally outweighs the potential benefits of prone sleeping. Prone positioning during sleep (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.

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.

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 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. Using nipples with smaller holes may also help by reducing the amount of air the baby "drinks" and therefore, how distends her abdomen becomes (which, in turn, increases reflux.) If your baby is breastfed, try pumping and then adding rice cereal to the breast milk.

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 a strong let-down reflux, 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.

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.

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 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.

Your doctor may recommend medications (such as Prilosec [omeprazole]) which reduces stomach acid) 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.

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.

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.

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.