Symptoms

Signs and symptoms of infant acid reflux may include:

• Spitting up
• Irritability during or after feedings
• Coughing
• Wheezing
• Refusing to eat
• Crying when placed on his or her back, especially after a feeding

In severe cases, your baby may arch his or her back while crying and this may look like your baby is having a seizure.

When to see a doctor Normal infant acid reflux doesn't interfere with a baby's growth or well-being. Contact your baby's doctor if your baby:

• Isn't gaining weight
• Spits up forcefully, causing stomach contents to shoot out of his or her mouth
• Spits up green or yellow fluid
• Spits up blood or a material that looks like coffee grounds
• Resists feedings
• Has blood in his or her stool
• Has other signs of illness, such as fever, diarrhea or difficulty breathing
• Begins vomiting at age 6 months or older

Some of these signs may indicate more-serious conditions, such as gastroesophageal reflux disease (GERD) or pyloric stenosis. GERD is a severe version of reflux that can cause pain, vomiting and poor weight gain. Pyloric stenosis is a rare condition in which a narrowed valve between the stomach and the small intestine prevents stomach contents from emptying into the small intestine.

Causes

The causes of infant acid reflux are generally simple. Normally, the ring of muscle between the esophagus and the stomach (lower esophageal sphincter) relaxes and opens only when you swallow. Otherwise, it's tightly closed — keeping stomach contents where they belong. Until this muscle matures, stomach contents may sometimes flow up the esophagus and out of your baby's mouth. Sometimes air bubbles in the esophagus may push liquid out of your baby's mouth. In other cases, your baby may simply drink too much, too fast.

Complications

Most cases of infant acid reflux clear up on their own without causing problems for your baby. Rarely, infant acid reflux can lead to poor growth or breathing problems. Some research indicates that babies who have frequent episodes of infant acid reflux may be more likely to develop gastroesophageal reflux disease during later childhood.

Appointment

If your baby has infant acid reflux, you'll likely start by seeing your child's pediatrician. Because appointments can be brief, it's a good idea to arrive well prepared. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

• Write down any symptoms your baby is experiencing. Note when the baby spits up. Is it every time he or she feeds? How much liquid is your baby spitting up? Does it seem like he or she is throwing up everything eaten?
• Make a list of key information. How often do you feed your baby? How often do those feeding sessions last? How often do you burp your baby during feedings? Are you breast-feeding. If not, what formula are you using, and have you recently switched formulas?
• Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions can help you make the most of your time together. Some basic questions you might want to ask your doctor include:

• What's the most likely cause of my baby's symptoms?
• Does my baby need any tests?
• Does this mean something is wrong with my baby?
• What treatments are available?
• What can I do to help my baby?
• Am I feeding my baby too much? Or, am I feeding my baby too often?
• Are there any brochures or other printed material that I can take with me? What websites do you recommend?

What to expect from your doctor Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over points you want to spend more time on. Your doctor may ask:

• When did your baby first begin experiencing symptoms?
• Does your baby spit up with every feeding, or only occasionally?
• How is your baby's temperament? Is he or she content between feedings?
• Have you recently switched from breast-feeding to bottle-feeding? Or, have you switched infant formulas?
• How often do you feed your baby?
• How much does your baby eat at each feeding?
• Does the same person feed your baby every time?
• If you have different caregivers, does everyone feed the baby the same way each time?
• In what position does your baby sleep?
• Does anything seem to improve your baby's symptoms?
• What, if anything, appears to worsen the symptoms?

What you can do in the meantime While you're waiting to see your baby's doctor, giving your baby smaller, more frequent feedings may help reduce the reflux. It also may help to keep your baby upright during feedings, and to take more frequent breaks to burp the baby.

Tests and diagnosis

Diagnosis of infant acid reflux is typically based on your baby's symptoms and a physical exam. If your baby is healthy, growing as expected and seems content, then further testing probably isn't necessary.

If your baby's doctor suspects a more serious condition, such as GERD, diagnostic tests may include:

• Lab tests. Your baby's doctor may do various blood and urine tests to identify or rule out possible causes of recurring vomiting and poor weight gain.
• Esophageal pH monitoring. To determine if irritability, sleep disturbances or other symptoms are associated with reflux, it may be helpful to measure the acidity in your baby's esophagus. The doctor will insert a thin tube through your baby's nose or mouth into the esophagus. The tube is attached to a device that monitors acidity. Your baby may need to remain in the hospital while being monitored.
• Upper GI series. If the doctor suspects a gastrointestinal obstruction, he or she may recommend a series of X-rays known as an upper gastrointestinal (GI) series. Before the X-rays, your baby is given a white, chalky liquid (barium) to drink. The barium coats the stomach, which helps any abnormalities show up more clearly on the X-rays.
• Upper endoscopy. Your baby's doctor may use this procedure to identify or rule out problems in the esophagus, such as narrowing (stricture) or inflammation (esophagitis). The doctor will insert a special tube equipped with a camera lens and light through your baby's mouth into the esophagus, stomach and first part of the small intestine. Samples of any suspicious tissue may be taken for analysis. For infants and children, endoscopy is usually done under general anesthesia.

Treatments and drugs

Most cases of infant acid reflux clear up on their own. Treatment may include:

• Feeding technique changes. Smaller, more frequent feedings, interrupting feedings to burp, or holding your baby upright during and after feedings may be all that's needed to ease infant acid reflux. If you're breast-feeding, your baby's doctor may suggest that you eliminate dairy products or certain other foods from your diet. If you feed your baby formula, sometimes switching brands helps.
• Medication. If your baby is uncomfortable, your pediatrician may prescribe infant doses of medications commonly used to treat heartburn in adults. Choices may include H-2 blockers, such as cimetidine (Tagamet) or ranitidine (Zantac), or proton pump inhibitors, such as omeprazole (Prilosec) or lansoprazole (Prevacid). It's important to note that otherwise healthy children taking these medications may face an increased risk of certain intestinal and respiratory infections. In addition, prolonged use of proton pump inhibitors has been linked to an increased risk of fractures of the hip, wrist and spine in adults.
• Alternative feeding methods. If your baby isn't growing well, higher calorie feedings or a feeding tube may be recommended.
• Surgery. Rarely, the muscle that relaxes to let food into the stomach (the lower esophageal sphincter) must be surgically tightened so that less acid is likely to flow back into the esophagus. The procedure, known as fundoplication, is usually reserved for the few babies who have reflux severe enough to interfere with breathing or prevent growth. Although surgery can reduce GERD symptoms, the complications are potentially serious — including persistent gagging during feedings.

Home remedies

Even with treatment, your baby will probably still experience reflux sometimes. To minimize reflux, consider these tips:

• Keep baby upright. Feed your baby in an upright position. Follow each feeding with 15 to 30 minutes in a sitting position. Try a front pack, backpack or infant seat. Gravity can help stomach contents stay where they belong. Be careful not to jostle or jiggle your baby while the food is settling.
• Try smaller, more frequent feedings. Feed your baby slightly less than usual if you're bottle-feeding or cut back a little on the amount of nursing time if you're breast-feeding.
• Take time to burp your baby. Frequent burps during and after each feeding can keep air from building up in your baby's stomach. To burp, sit your baby upright, supporting his or her head with your hand. Avoid burping your baby over your shoulder, which puts pressure on your baby's abdomen.
• Check the nipple. If you're using a bottle, make sure the hole in the nipple is the right size. If it's too large, the milk will flow too fast. If it's too small, your baby may get frustrated and gulp air. A nipple hole that's the right size will allow a few drops of milk to fall out when you hold the bottle upside down.
• Thicken the formula or breast milk. If your baby's doctor approves, add a small amount of rice cereal to your baby's formula or expressed breast milk. You may need to enlarge the hole in the nipple to make sure your baby can drink the thickened liquid.

Remember, infant acid reflux is usually little cause for concern. Just keep plenty of burp cloths handy as you ride it out.