Gastroesophageal 


Reflux in Infants
 

National Digestive Diseases Information Clearinghouse 

National 

Institute of 

Diabetes and 

Digestive 

and Kidney 

Diseases 

NATIONAL 

INSTITUTES 

OF HEALTH 

U.S. Department 

of Health and 

Human Services 

What is gastroesophageal 

reflux (GER)? 

Gastroesophageal reflux (GER) occurs 

when stomach contents reflux, or back up, 

into the esophagus during or after a meal. 

The esophagus is the tube that connects the 

mouth to the stomach. A ring of muscle at 

the bottom of the esophagus opens and 

closes to allow food to enter the stomach. 

This ring of muscle is called the lower 

esophageal sphincter (LES). The LES 

normally opens to release gas after meals. 

With infants, when the LES opens, stomach 

contents often reflux into the esophagus 

and out the mouth, resulting in regurgitation, or spitting up, and vomiting. GER 

can also occur when babies cough, cry, or 

strain. 

What are the symptoms 

of GER? 

GER is common in healthy infants. More 

than half of all babies experience reflux in 

the first 3 months of life, but most stop 

spitting up between the ages of 12 to 24 

months. Only a small number of infants 

have severe symptoms. An infant with 

GER may experience 

•	 spitting up 

•	 vomiting 

•	 coughing 

•	 irritability 

•	 poor feeding 

•	 blood in the stools 

In a small number of babies, GER results 

in symptoms that cause concern. These 

symptoms include 

•	 poor growth due to an inability to
 

hold down enough food
 

•	 irritability or refusing to feed due to 

pain 

•	 blood loss from acid burning the
 

esophagus
 

•	 breathing problems 

These problems can be caused by disorders 

other than GER. Your health care 

provider will need to determine whether 

GER is the cause of your child’s symptoms. 

Digestive system noting the mouth, esophagus, lower 

esophageal sphincter (LES), stomach, and small 

intestine. 
How is GER diagnosed? 

An infant who is consistently spitting up or 

vomiting may have GER. The doctor or 

nurse will talk with you about your child’s 

symptoms and examine your child. Tests 

may be ordered to help determine whether 

your child’s symptoms are related to GER. 

Sometimes treatment is started without 

tests. If the infant is healthy, content, and 

growing well, often no tests or treatment 

are needed. 

What is the treatment 

for GER? 

The treatment for reflux depends on an 

infant’s symptoms and age. Some babies 

may not need treatment because GER 

often resolves by itself. Healthy babies may 

only need their feedings thickened with 

cereal and to be kept upright after eating. 

Overfeeding can aggravate reflux, so your 

health care provider may suggest different 

ways of handling feedings. For example, 

smaller quantities with more frequent 

feedings can help decrease the chances of 

Call your child’s health care 

provider right away if any of 

the following occur: 

• vomiting large amounts or persistent 

projectile (forceful) vomiting, 

particularly in infants younger than 

2 months old 

• vomiting fluid that is green or yellow 

or that looks like coffee grounds or 

blood 

• difficulty breathing after vomiting or 

spitting up 

• refusing food that seems to result in 

weight loss or poor weight gain 

• excessive crying and irritability 

regurgitation. If a food allergy is suspected, 

you may be asked to change the baby’s 

formula. Breastfeeding mothers may be 

asked to change their own diets for 1 to 2 

weeks. If a child is not growing properly, 

higher-calorie food or tube feeding may be 

recommended. 

When an infant is uncomfortable, has difficulty sleeping or eating, or does not grow, 

your health care provider may suggest a 

trial of medication to decrease the amount 

of acid in the stomach. Any potential complications related to the medication will be 

explained. However, most infants don’t 

need medication and outgrow reflux by 1 

or 2 years of age. 

*If medication is needed, treatment will 

often start with a class of medications 

called H2-blockers, also called H2-receptor 

agonists. These drugs help keep acid from 

backing up into the esophagus. H2-blockers are often used to treat children with 

GER because they come in liquid form. 

H2-blockers include 

• cimetidine (Tagamet) 

• ranitidine (Zantac) 

• famotidine (Pepcid) 

• nizatidine (Axid) 

A second class of medications often used to 

reduce stomach acid is proton-pump 

inhibitors (PPIs), which block the production of stomach acid. PPIs include 

• esomeprazole (Nexium)
 

• omeprazole (Prilosec)
 

• lansoprazole (Prevacid) 

• rabeprazole (Aciphex) 

• pantoprazole (Protonix) 

* The authors of this fact sheet do not specifically endorse 

the use of drugs for children that have not been tested in 

children (“off label” use). Such a determination can only 

be made under the recommendation of the treating 

health care provider. 

2 Gastroesophageal Reflux in Infants 
Specific Instructions for Infants 

with GER 

•	 If you feed your baby with a bottle, 

add up to 1 tablespoon of rice cereal 

to 2 ounces of infant milk. You can 

add cereal to expressed milk if you are 

breastfeeding. If the mixture is too 

thick for your baby you can change 

the nipple size or cut a little “x” in 

the nipple. 

•	 Burp your baby after he’s consumed 1 

or 2 ounces of formula. For breast-fed 

infants, burp after feeding on each 

side. 

•	 Do not overfeed. Talk with your
 

infant’s doctor or nurse about the
 

amount of formula or breast milk
 

that your baby is consuming.
 

•	 When possible, hold your infant 

upright in your arms for 30 minutes 

after feedings. 

•	 Infants with GER should usually sleep 

on their backs, as is suggested for all 

infants. Rarely, a physician may suggest alternative sleep positions. 

Points to Remember 

•	 GER occurs when stomach contents 

back up into the esophagus. 

•	 GER is common in infants but most 

grow out of it. 

•	 In infants, GER may cause spitting 

up, vomiting, coughing, poor feeding, or blood in the stools. 

•	 Treatment depends on the infant’s 

symptoms and age and may include 

changes in eating and sleeping 

habits. Medication may also be an 

option. Only rarely and in severe 

cases is surgery required. 

Hope Through Research 

The National Institute of Diabetes and 

Digestive and Kidney Diseases, through its 

Division of Digestive Diseases and Nutrition, supports basic and clinical research 

into gastrointestinal diseases. Researchers 

are studying the risk factors for developing 

GER and what causes the LES to open, 

with the aim of improving future treatment 

for GER. They are also studying the efficacy and safety of drug therapy for the treatment of GER in children and investigating 

the effectiveness of medications compared 

with surgery. 

For More Information 

North American Society for Pediatric 

Gastroenterology, Hepatology, and 

Nutrition (NASPGHAN) 

P.O. Box 6 

Flourtown, PA 19031 

Phone: 215–233–0808 

Fax: 215–233–3918 

Email: naspghan@naspghan.org 

Internet: www.NASPGHAN.org 

NASPGHAN’s Children’s Digestive Health 

and Nutrition Foundation (CDHNF) 

Internet: www.CDHNF.org 

www.KidsAcidReflux.org 

www.TeensAcidReflux.org 

The U.S. Government does not endorse or 

favor any specific commercial product or 

company. Trade, proprietary, or company 

names appearing in this document are 

used only because they are considered 

necessary in the context of the information 

provided. If a product is not mentioned, 

the omission does not mean or imply that 

the product is unsatisfactory. 

3	 Gastroesophageal Reflux in Infants 
National Digestive Diseases 

Information Clearinghouse 

2 Information Way 

Bethesda, MD 20892–3570 

Phone: 1–800–891–5389 

Fax: 703–738–4929 

Email: nddic@info.niddk.nih.gov 

Internet: www.digestive.niddk.nih.gov 

The National Digestive Diseases Information 

Clearinghouse (NDDIC) is a service of the 

National Institute of Diabetes and Digestive 

and Kidney Diseases (NIDDK). The NIDDK 

is part of the National Institutes of Health 

under the U.S. Department of Health and 

Human Services. Established in 1980, the 

Clearinghouse provides information about 

digestive diseases to people with digestive 

disorders and to their families, health care 

professionals, and the public. The NDDIC 

answers inquiries, develops and distributes 

publications, and works closely with 

professional and patient organizations and 

Government agencies to coordinate resources 

about digestive diseases. 

Publications produced by the Clearinghouse are 

carefully reviewed by both NIDDK scientists 

and outside experts. This fact sheet was 

reviewed by NASPGHAN. 

This information was prepared in 

partnership with the North American 

Society for Pediatric Gastroenterology, 

Hepatology, and Nutrition 

(NASPGHAN), the Children’s Digestive Health and Nutrition Foundation 

(CDHNF), and the Association of 

Pediatric Gastroenterology and Nutrition Nurses (APGNN). The information is intended only to provide general 

information and not as a definitive 

basis for diagnosis or treatment in any 

particular case. You should consult 

your child’s doctor about your child’s 

specific condition. 

THE ASSOCIATION OF PEDIATRIC GASTROENTEROLOGY 

AND NUTRITION NURSES 

This publication is not copyrighted. The 

Clearinghouse encourages users of this fact 

sheet to duplicate and distribute as many 

copies as desired. 

This fact sheet is also available at 

www.digestive.niddk.nih.gov. 

U.S. DEPARTMENT OF HEALTH 

AND HUMAN SERVICES 

National Institutes of Health 

NIH Publication No. 06–5419 

August 2006