Treating Reflux in Infants

Infant reflux—when stomach contents come up into the esophagus—is a common problem, especially among babies who were born premature. It occurs when the lower esophageal sphincter (LES)—a muscle at the top of the stomach—is weak, relaxed, or underdeveloped.

For most infants, reflux is mild and doesn't need treatment. Simple strategies can help improve issues like spitting up and discomfort. Reflux symptoms usually resolve on their own by the time the child is 12 to 14 months old, when the LES is stronger and well-developed.

Mother holding infant upright after feeding

s0ulsurfing - Jason Swain / Getty Images

However, there are cases that are significant enough to warrant treatment. Babies with gastroesophageal reflux disease (GERD)—severe infant reflux—may require medication and, less commonly, surgery.

This article discusses a variety of treatment options for infant reflux, including things you can do at home to reduce it and help your baby feel better. It also provides signs that your baby may have GERD instead of just reflux.

At-Home Strategies

Whether your baby's reflux is mild or severe, there are some strategies you can try at home 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 frequently may reduce spit-up and reflux symptoms.
  • Upright position after feedings: Holding your baby upright for about 30 minutes after each feeding can help reduce the reflux symptoms. Placing your baby in a semi-upright position in a swing or bouncer after feedings can also help.
  • Burping your baby: Burp your baby frequently during and after feedings to keep air from building up in their stomach, which can push its contents up.
  • 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—like soy or a hypoallergenic formula—may help.
  • 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 GERD symptoms. If you are advised to try eliminating dairy from your diet, be patient. It can take up to two weeks to see results.
  • Formula thickeners: Research shows that thickening an infant's formula with powdered infant cereal may reduce their GERD symptoms within one to eight weeks. Add 1 tablespoon of rice cereal per ounce of formula, or use a pre-thickened formula.

According to the American Academy of Pediatrics, infants should not be introduced to foods other than infant formula or breast milk before they are six months old. Unless your pediatrician advises you otherwise, assume that this includes thickened formula.

You may have also heard that elevating the head of your baby's crib could reduce GERD symptoms while they sleep. The American Academy of Pediatrics not only says that this is "ineffective in reducing gastroesophageal reflux," they also strongly advise against this due to the risk of sudden infant death syndrome (SIDS).

Your doctor may recommend elevating the head of the crib if your baby has a greater risk of dying from GERD than they do from SIDS. Otherwise, the only safe way for your baby to sleep is flat on their back without blankets or pillows.

Recap

What your baby eats, how and when they are fed, and even what nursing moms eat can all affect infant reflux.

Medications

The above strategies may be enough to improve mild cases of infant reflux. When that's not the case for your baby, or they are experiencing any of the following signs of GERD, medication may be needed:

  • Poor growth
  • Severe pain
  • Refusal to eat due to pain
  • Coughing, choking, or wheezing
  • Breathing problems due to inhaling refluxed milk

Your infant's pediatrician may also prescribe medication if your baby has inflammation in their esophagus that damages the esophageal lining, a condition known as esophagitis:

Medications for infant reflux include antacids, H2 blockers, and proton-pump inhibitors. Some forms of these medications can be found overt the counter (OTC), while others require a prescription.

The first medication your baby tries may do the trick, but be prepared for the possibility of some trial and error to find the medication that is most effective for them.

Antacids

OTC antacids suitable for infant reflux include Mylanta, Maalox, and Tums. While Mylanta can be given to infants who are older than 1 month, Maalox and Tums are not recommended for those under a year old.

Regular use of antacids may help infants with mild symptoms of GERD. However, there are some risks that you should discuss with your pediatrician before giving your infant antacids.

A growing body of evidence suggests that infants who take high doses of antacids may have a higher risk of developing rickets, a condition in which a child's bones become soft and weak.

Maalox and Mylanta are also known to have a laxative effect at high doses and could cause your infant to have diarrhea. If you use one of them, it's important to strictly adhere to the dosing instructions.

How They Are Used

Mylanta is available in a liquid form that you can mix with water or your baby's formula. Your pediatrician may occasionally recommend an antacid that comes in a chew tablet form, which you will need to crush up into a fine powder and mix into your baby's formula.

If your pediatrician advises you to give your infant an antacid, they will instruct you on the proper dosage. For example, while Mylanta can be given up to three times per day, your pediatrician may advise a different dosage, depending on your baby's weight, age, and other needs.

In general, antacids should not be taken for more than two weeks. Always read labels closely and call your pediatrician if your infant's reflux symptoms don't clear up within two weeks of starting antacid formula.

Make sure any medications you give your infant do not contain aspirin or bismuth subsalicylate. The use of these drugs in children has been linked to a life-threatening condition called Reye's syndrome, which causes brain swelling and liver failure.

H2 Blockers

Histamine (H2) blockers block the hormone histamine to reduce the amount of acid the stomach produces. Doctors also prescribe them because they help heal the esophageal lining.

Prescription H2 blockers are considered safe and have been used extensively to treat reflux in babies and children. They do come with a small risk of side effects, including abdominal pain, diarrhea, and constipation.

Some research also suggests that giving infants H2 blockers long-term could disrupt the protective effects of their intestinal lining and increase their risk of certain bacterial infections.

How They Are Used

Over-the-counter H2 blockers like Tagamet (cimetidine) and Pepcid (famotidine) can be found at your local pharmacy in liquid and tablet form. These OTC medications are not recommended for children younger than 12, so your infant will need a prescription instead.

H2 blockers begin to take effect quickly and can reduce your infant's symptoms in as little as 30 minutes. Your doctor will determine the right dosage for your infant upon prescribing the medication.

Infection Risk

H2 blockers and PPIs reduce the amount of stomach acid in your infant's stomach. Because stomach acid helps protect the body from infection, your infant's risk of pneumonia and gastrointestinal infection is higher when taking these medications.

Proton-Pump Inhibitors

Proton-pump inhibitors (PPIs) are newer medications that are more effective than H2 blockers at reducing stomach acid.

PPIs that are available for prescription-use only include Nexium (esomeprazole), Prilosec (omeprazole), Prevacid (lansoprazole), and Protonix (pantoprazole). Although you can find some proton proton-pump inhibitors like Prilosec over the counter, they are generally not recommended for children younger than 1 year old.

PPIs should be considered with caution, as they are associated with more long-term side effects than H2 blockers, including liver problems, polyps in the stomach, and lowered immunity against bacterial infection.

How They Are Used

Doctors usually prescribe PPIs for a course of four to eight weeks. Your doctor will consider your infant's age, weight, and other factors when determining a dosage.

To get certain PPIs in liquid form, you will need to use a pharmacy that compounds, or mixes, its own medications.

What About Motility Agents?

In the past, motility agents like Reglan were used to speed up digestion, empty the stomach faster, and prevent reflux.

Due to severe side effects, these medications are no longer prescribed for infants.

Recap

Antacids, H2-blockers, and PPIs may be considered when your infant is not responding to non-drug strategies to reduce their reflux and/or their are medical concerns with letting symptoms persist. While OTC options of some of these drugs are OK to use in infants, that's not the case across the board. Follow your pediatrician's instructions.

Surgery for Infant Reflux

In rare cases when GERD symptoms become life-threatening, a surgical procedure called fundoplication may be performed. Your infant's pediatrician may recommend fundoplication if:

  • GERD lasts well beyond the first year of life and does not respond to treatment
  • Your infant develops recurrent aspiration pneumonia caused by regurgitated stomach contents that are breathed into the airways
  • Your baby has episodes of apnea, in which they are fully or partially unable to breathe for more than 20 seconds when regurgitating
  • They develop an irregular heart rhythm, known as bradycardia
  • Their airways become damaged, resulting in a chronic lung disease called bronchopulmonary dysplasia
  • Your infant is not growing properly due to malnutrition
  • Your baby's esophagus is abnormally tight (esophageal stricture) due to inflammation, a condition that increases their risk of choking

During a fundoplication surgery, 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 an effective solution for children with severe reflux that doesn't respond to medication, fundoplication surgery is a major surgical procedure that has a number of possible complications. It also has a high failure rate in some children. As such, it is considered as a last resort.

Talk to your healthcare provider to see if fundoplication might be right for your child.

Working With Your Pediatrician

Reflux can be challenging to manage and, at times, disheartening. Many families try a number of remedies before finding one that works for their baby, only to have that remedy stop working after a couple of months.

Try to have patience and keep the lines of communication with your pediatrician wide open. It can help to keep track of what efforts you try when and how your baby reacts. Also log any changes to their diet or routine, as those could affect their symptoms too.

If your baby has GERD, you might consider consulting with a pediatric gastroenterologist—a doctor who specializes in digestive health issues in children.

Summary

For most infants, reflux symptoms will improve on their own by the time they are 14 months old. When symptoms are mild, feeding your infant smaller meals, keeping them upright after feedings, and other strategies may be sufficient.

If your baby is diagnosed with GERD, your pediatrician may recommend antacids, H2 blockers, or PPIs. Although effective, they come with a risk of side effects that you and your pediatrician should weigh. Surgery may be considered when GERD symptoms put your infant's life at risk.

A Word From Verywell

It's normal for babies to spit up within one to two hours after a feeding. It's also normal to be unsure whether or not your baby is spitting up a normal amount—especially if you are a first-time parent.

Between 70% to 85% of infants regurgitate their meal at least once a day in the first two months of their life. If that sounds like your baby, there's no need to panic. Although, if ever you are unsure, don't hesitate to reach out to your pediatrician for clarity.

Was this page helpful?
17 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.
  1. Eichenwald EC. Diagnosis and management of gastroesophageal reflux in preterm infants. Pediatrics. 2018 Jul;142(1):1-11. doi:10.1542/peds.2018-1061

  2. Stanford Children's Health. GERD (gastroesophageal reflux disease) in children.

  3. Baird DC, Harker DJ, Karmes AS. Diagnosis and treatment of gastroesophageal reflux in infants and children. Am Fam Physician. 2015 Oct;92(8):705-717. PMID:26554410

  4. Stanford Children's Health. GERD (gastroesophageal reflux disease) in children.

  5. Lightdale JR, Gremse DA; American Academy of Pediatrics Section on Gastroenterology, Hepatology, and Nutrition. Gastroesophageal reflux: management guidance for the pediatrician. Pediatrics. 2013;131(5):e1684-e1695. doi:10.1542/peds.2013-0421

  6. Kwok TC, Ojha S, Dorling J. Feed thickener for infants up to six months of age with gastro-oesophageal refluxCoch Data Syst Rev. 2017 Dec;2017(12):CD003211. doi:0.1002/14651858.CD003211.pub2

  7. American Academy of Pediatrics Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics. 2012;129(3):e827-e841. doi:10.1542/peds.2011-3552

  8. American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome. SIDS and other sleep-related infant deaths: updated 2016 recommendations for a safe infant sleeping environment. Pediatrics. 2016;138(5):e20162938. doi:10.1542/peds.2016-2938

  9. Gonzalez Ayerbe JI, Hauser B, Salvatore S, Vandenplas Y. Diagnosis and management of gastroesophageal reflux disease in infants and children: from guidelines to clinical practicePediatr Gastroenterol Hepatol Nutr. 2019 Mar;22(2):107-121. doi:10.5223/pghn.2019.22.2.107

  10. University of Virginia. Treatment of GE reflux.

  11. C.S. Mott Children's Hospital. Gastroesophageal reflux in babies in children. Updated April 2020.

  12. Gupta R, Tran L, Norori J, et al. Histamine-2 receptor blockers alter the fecal microbiota in premature infants. J Pediatr Gastroenterol Nutr. 2013 Apr;56(4):397-400. doi:10.1097/MPG.0b013e318282a8c2

  13. Azizollahi HR, Rafeey M. Efficacy of proton pump inhibitors and H2 blocker in the treatment of symptomatic gastroesophageal reflux disease in infantsKorean J Pediatr. 2016 May;59(5):226-230. doi:10.3345/kjp.2016.59.5.226

  14. Safe M, Chan WH, Leach ST, Sutton L, Lui K, Krishnan U. Widespread use of gastric acid inhibitors in infants: Are they needed? Are they safe?World J Gastrointest Pharmacol Ther. 2016 Nov;7(4):531-539. doi:10.4292/wjgpt.v7.i4.531

  15. Gunasekaran T, Kakodkar S, Berman J. Proton pump inhibitors may not be the first line treatment for GERD in infants. JPGN. 2018 Jan;66(1):26. doi:10.1097/MPG.0000000000001760

  16. Yoo BG, Yang HK, Lee YJ, Byun SY, Kim HY, Park JH. Fundoplication in neonates and infants with primary gastroesophageal refluxPediatr Gastroenterol Hepatol Nutr. 2014 Jun;17(2):93-97. doi:10.5223/pghn.2014.17.2.93

  17. National Institute of Diabetes and Digestive and Kidney Diseases. Definition & facts for GER & GERD in infants. Reviewed November 2020.