Treating Reflux in Infants

Infant reflux—when stomach contents come up into the esophagus—is a common problem, especially among babies who are 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

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However, there are cases that are significant enough to warrant medical 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 explains why your baby may have GERD instead of 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.
  • 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.
  • 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.
  • 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; breastfed babies who have sensitivity to cow's milk protein 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 infant formula with powdered infant cereal may reduce GERD symptoms within one to eight weeks. Add 1 teaspoon of rice cereal per 2 ounces of formula or use a pre-thickened formula.

Infants should not be introduced to foods other than infant formula or breast milk before they are 6 months old, the American Academy of Pediatrics (AAP) says. Unless your pediatrician advises you otherwise, 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. However, the AAP says that this is "ineffective in reducing gastroesophageal reflux." It also advises against this tactic 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 higher risk of dying from GERD than SIDS. Otherwise, the only safe way for your baby to sleep is flat on their back without blankets or pillows.

Medications

At-home strategies may be enough to improve mild cases of infant reflux. When that's not the case, medication may be needed. Signs that your baby may need medical treatment include:

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

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 that are sometimes prescribed for treating infant reflux include antacids, H2 blockers, and proton-pump inhibitors (PPIs). Sometimes, over-the-counter (OTC) formulations can be used. Or your baby's pediatrician might recommend 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.

Antacids

OTC antacids suitable for treating infant reflux include Mylanta, Maalox, and Tums. While Mylanta and Maalox can be given to infants who are older than 1 month, Tums is not recommended for those under 1 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. If you use one of them, it's important to strictly adhere to the dosing instructions.

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.

How They Are Used

Mylanta is available in a liquid form that you can mix with water or with 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 factors.

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 the antacid formula.

Babies and Aspirin Don't Mix

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 such as Pepcid (famotidine) 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 the risk of certain bacterial infections.

How They Are Used

Over-the-counter H2 blockers like Tagamet (cimetidine) and Pepcid 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 if their pediatrician recommends an H2 blocker.

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 can be higher when taking these medications.

Proton-pump Inhibitors

Proton-pump inhibitors (PPIs) are often considered 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-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 find a pharmacy that compounds, or mixes, its own medications.

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 improving with non-drug strategies. While OTC options of some of these drugs are OK for infants to ingest, this is 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 pediatrician may recommend it if:

  • GERD lasts well beyond the first year of life and does not improve with 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 fundoplication surgery, the top of the stomach is wrapped around the esophagus, tightening the LES and making it more difficult for food to come 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. The procedure might not be effective for some children.

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 few months.

The situation may try your patience, so keep the lines of communication with your pediatrician open. It can help to keep track of the interventions you attempt and how your baby reacts to them. Also, keep a log of any changes to their diet or routine, as they can affect their symptoms, too.

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

Summary

Reflux symptoms typically improve on their own by the time most infants 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 consider. Surgery may be considered when GERD symptoms cause complications.

A Word From Verywell

It's not unusual for babies to spit up within one or two hours after a feeding. It's also normal to be unsure whether your baby is spitting up a normal amount, especially if you're a first-time parent. Between 70% and 85% of infants regurgitate part of their meal at least once a day during the first two months of life. If this sounds like your baby, try not to panic, though you may have to find a way to supplement your baby's nutritional needs.

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