Gastroesophageal Reflux in Infants

Gastroesophageal reflux is a medical term that refers to the reverse movement from the stomach up the esophagus. When babies spill or vomit, this is what is happening - milk is coming back up the esophagus from the stomach.

Spilling is a term I use to describe the small vomits that babies usually do after a feed or with burping.

Spilling in babies is normal and is usually benign and of no concern - you can read why babies spill so easily on this page and also about some techniques that may help your baby. Occasionally, there is something else going on that needs treatment - again, read on to find out more.

Information on this page is summarised in the list below - click on a link to go to that section directly, or read on for a full outline of this common problem

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What is gastroesophageal reflux (GER)?

GER occurs when contents from the stomach (gastro-) come back (reflux) up the esophagus. Most people have experienced this at some stage. Any time you vomit, contents from the stomach come back up the esophagus. This is gastro-esophageal reflux. It is also known as gastro-oesophageal reflux in Britain and Australasia.

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Why do babies get gastroesophageal reflux?

It is easy for babies to reflux because:

  • they have a liquid diet
  • they have relatively weak muscles surrounding the esophagus where is enters the stomach, so there is less resistance to keep fluid in the stomach. There is no valve at the end of the esophagus, however the muscles of the diaphragm encircle it allowing closure at the junction of the esophagus and stomach
  • they spend a lot of time lying down so gravity isn't working for them but against them. When babies are upright, they don't have good muscle tone and so lean forward putting pressure on the stomach, forcing its contents out.

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Does it matter that my baby has reflux?

Not in most cases - it's a normal part of being a baby to have spills (vomits). So if your baby is growing and not upset by vomiting, you don't need to be too concerned either.

However, it does matter if the reflux is bad enough to stop your baby gaining weight normally or is causing acid to burn your baby's esophagus (which will cause your baby distress). When either of these things happens, we call it Gastroesophageal Reflux Disease (GERD).

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How do I know if my baby has Gastroesophageal Reflux Disease(GERD)?

If your baby has GERD, you will know because she will not be gaining weight or she will be distressed with vomiting. Distress in GERD will be crying with vomiting, crying when lying flat or sometimes babies will arch their backs with the pain.

Occasionally, no vomiting is seen although there is still acid refluxing back into the esophagus causing pain - this is called silent reflux.

So your baby may have GERD if she

  • is not gaining weight
  • has a lot of distress with vomiting

if she is arching her back and seems very distressed after feeds and when lying flat, but is not vomiting, she may have silent reflux. To read more about GERD, click here.

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What is the treatment of gastroesophageal reflux?

Reflux which is not causing distress and where the baby is gaining weight can be managed with relatively simple measures such as:

  • keep your baby upright for a while after a feed.
  • you could try thickening the feeds - however, this is not so convenient if you are breast-feeding. There are anti-reflux formulas that have a thickening agent in them if you are formula feeding. You should not stop breast-feeding to give an anti-reflux formula, though (the benefits of breast-feeding are too great).
  • there are anti-gas medications such as Gaviscon (alginic acid) that form a foamy covering on top of the stomach contents after a feed and sometimes this can help reduce the spilling - you mix the medication with milk or water and give after feeds. To read more on Gaviscon, click here.

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Should I prop my baby up?

The American Academy of Pediatrics (AAP) does not recommend propping babies up for sleep as the baby is likely to fall to the end of the bed where babies are more at risk from suffocation etc from bed clothes over their heads.

However, some mothers find that propping their baby up at 30-45 degrees can help reflux symptoms, so if you do prop your baby to help prevent gastroesophageal reflux, you need to do so safely.

If you are going to try propping your baby for gastroesophageal reflux, put something like a book or brick under the legs at the head of the crib (cot) so the crib (cot) is on an angle of 30-45 degrees. Don't prop your baby up on cushions or pillows. Tie a scarf of at least 15 cm (6 inches) width to one side of the head end of the cot (crib), bring it down over your baby's body and between her legs and then bring it back up under her to tie at the other side of the head end of the cot (crib). This is a simple harness device to keep her from slipping down the bed - because if she slipped down the end of the bed she would end up all hunched over putting pressure on her stomach and this would cause vomiting. Make sure that if you use this system, the scarf is firmly attached as your baby could get entangled in loose fabric and this is definitely something you don't want to happen. You can also buy sheets that wrap around the tummy and hold the baby in position.

Babies should always be on their back to sleep and so you should prop your baby on her back.

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Will my baby choke on her vomit if she is on her back?

Sometimes, mothers are worried that babies will choke on their vomit if they are lying on the back. Actually, babies have inborn mechanisms that prevent them choking on their vomit while on their back, so you don't have to worry about that.

A baby lying on her back will turn her head slightly if she vomits when on her back. She will be able to keep her airway clear. A baby lying on her tummy is more likely to have difficulty if she vomits as the vomit may block her nose or she may be lying in vomit and this is actually more dangerous.

In some rare cases where babies have abnormalities of the airway, doctors may recommend sleeping on the tummy, but unless your doctor has specifically advised this, then put your baby to sleep on her back.

It is very important that your baby is put to sleep on her back - sleeping on the tummy can increase the risk of sudden infant death syndrome (SIDS or cot death or crib death).

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How long will gastroesophageal reflux last?

Every baby is different, but most GER will resolve by itself once your baby is more upright and having more solid food, so by 7-8 months of age. Some babies will just continue to reflux and so vomit for longer but if they are growing well, there is probably not too much to worry about.

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Useful Resources

Children's Digestive Health and Nutrition website - you can download useful guides from this site


References

Kumar & Sarvananthan. Gastro-oesophageal reflux in children. Clinical Evidence, BMJ Publishing Group. May 2006.


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To read more about Gastroesophageal Reflux Disease, click here - information on acid reflux and its treatment, as well as information on silent reflux.

To read more on Gaviscon, click here

To go to the Vomiting page, click here

To go to the Newborn Baby problem page, click here

To return to the Home page, click here


Last reviewed 1 November 2011

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Dr Maud MD

Dr Maud MD (MBChB, FRACP, FRCPCH), a specialist pediatrician, provides health information and medical advice for parents of babies and toddlers. Read more about Dr Maud.



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