Treating Reflux in Infants

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Infant reflux is a common problem, especially among babies who were born premature. In reflux, the muscle at the top of the stomach (called the lower esophageal sphincter, or LES) allows stomach contents to come up out of the stomach and into the esophagus.

For most babies, reflux is mild. Babies may spit up frequently, but they are otherwise happy and healthy. This is normal and doesn't need treatment.

In other babies, reflux can be severe. Reflux that is severe enough to need treatment is called gastroesophageal reflux disease (GERD).

GERD in infants needs treatment if the baby:

  • Has poor growth
  • Is in severe pain
  • Refuses to eat due to pain
  • Has breathing problems due to inhaling refluxed milk

Working With Your Pediatrician

Managing GERD in infants can be time-consuming and disheartening. Many families try a number of remedies before finding one that works for them, only to have that remedy stop working after a couple of months.

If your baby has GERD, then working closely with a pediatrician who knows your child and what has and has not worked before will help you find the best treatments for your baby's reflux.

Home Remedies

Whether your baby's reflux is mild or severe, there are some home remedies that may help reduce their symptoms.

  • Smaller, more frequent feedings: Babies are less likely to spit up if their tummies are not as full. Giving your baby smaller feedings more often may reduce spit-up and symptoms of reflux.
  • Upright position after feedings: Holding your baby upright for about 30 minutes after each feeding can help reduce the symptoms of severe reflux. Placing your baby in a semi-upright position in a swing or bouncer after feedings can also help.
  • Changing your baby's formula: If your baby's reflux symptoms are caused by a food allergy, then changing to a special infant formula with a different protein makeup (such as a soy or a hypoallergenic formula) may help. Talk to your doctor before changing your baby's formula to make sure that your baby is getting adequate nutrition.
  • Changing your diet: If you're breastfeeding, then your baby may be reacting to foods in your diet. Cow's milk protein is a common offender, and breastfed babies with cow's milk protein sensitivities may experience symptoms of GERD.

If you are breastfeeding and your child's pediatrician thinks that cow's milk could be the problem, you may be advised to try eliminating dairy from your diet to see if this helps your baby. But be patient—it can take up to two weeks for eliminating dairy to help.


If your baby still has symptoms of GERD even after trying the home remedies outlined above, then talk to your pediatrician to see if medications may help. It may take time to find the medication that is most effective for your baby, as there are many different types of medication available to treat reflux.

Medications for infant reflux include thickening agents, antacids, H2 blockers, proton-pump inhibitors, and motility agents.

Thickening Agents

Although it isn't a medication, using rice cereal to thicken your baby's formula may help keep milk in the stomach. Use about 1 tablespoon of rice cereal per ounce of formula, or use a formula that already has rice added.

In European countries, Gaviscon for infants (which is different from the adult Gaviscon sold in the US) is sometimes used to form a thickened layer of milk in the stomach, preventing reflux.


Regular antacids may help infants with mild symptoms of GERD. Mylanta, Maalox, and Tums are typical antacids that may help with acid reflux in infants.

H2 Blockers

H2 blockers (Tagamet, Pepcid) reduce the amount of acid produced by the stomach and have been extensively used to treat reflux in babies and children. Side effects may include diarrhea, constipation, and abdominal pain.

Proton-Pump Inhibitors

Proton-pump inhibitors (PPIs) are newer medications that are more effective than H2 blockers at reducing stomach acid. PPIs include Nexium, Prilosec, Prevacid, Aciphex, and Protonix.

To get certain PPIs in liquid form, you will need to use a pharmacy that compounds, or mixes, its own medications. PPIs may cause more long-term side effects, including liver problems and polyps in the stomach, than H2 blockers.

Motility Agents

In the past, motility agents (Reglan and Propulsid) were used to help the body digest faster, preventing reflux by emptying the stomach faster. Due to severe side effects, these medications are no longer prescribed for infants.

Even if you are using over-the-counter remedies for your baby, be sure to consult your pediatrician before using any anti-reflux medication. Medications affect infants differently from how they affect adults and older children, and may not always be safe for your baby.

Surgery for Infant Reflux

In very rare cases, GERD lasts well beyond the first year of life, causes severe symptoms, and does not respond to treatment. In these cases, a surgical procedure called fundoplication may be performed.

In fundoplication, the top of the stomach is wrapped around the esophagus, tightening the LES and making it more difficult for food to reflux out of the stomach.

Although it can be a good option for children with severe reflux that doesn't respond to medications, fundoplication surgery is a major surgical procedure that has a number of possible complications. This surgery has a high failure rate in some children. Talk to your doctor to see if fundoplication might be right for your child.

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