Acid Reflux In Newborns: What's Normal?

Acid reflux, or gastroesophageal reflux (GER), is when food or milk from a baby's stomach travels back up into their oesophagus, which may lead to spitting up or vomiting. This is very common in babies, especially in their first year, and is usually harmless. However, acid reflux can sometimes be a sign of gastroesophageal reflux disease (GERD) or other conditions that require medical attention.

Acid reflux symptoms in newborns

Acid reflux, or gastroesophageal reflux (GER), is when food from a baby's stomach travels back up into their oesophagus, which may lead to spitting up or vomiting. This is very common in babies and usually harmless, but it can sometimes be a sign of gastroesophageal reflux disease (GERD) or other conditions that require medical attention.

Symptoms of GER

GER is common in infants and usually resolves itself. The main symptom is spitting up, which can happen several times a day in the first 3 months of a baby's life. Other symptoms include:

• Frequent vomiting
• Irritability, especially after eating
• Crying for more than 3 hours a day with no medical cause (colic)
• Gagging or trouble swallowing
• Poor weight gain or weight loss
• Wheezing or trouble breathing
• Arching of the back, often during or right after eating

Symptoms of GERD

GERD is a more serious and long-lasting type of reflux. It is characterised by repeated symptoms that are bothersome or lead to complications. Symptoms include:

• Poor weight gain, weight loss, and failure to thrive
• Feeding refusal or lengthy feedings
• Irritability after eating
• Difficulty swallowing or pain when swallowing
• Stomach pain, chest pain, and pain in other abdominal areas
• Long-term coughing, wheezing, or hoarseness
• Recurring laryngitis, pneumonia, sinusitis, or inflammation of the middle ear
• Crying more than usual or being extremely irritable
• Signs of bleeding in the digestive tract, such as blood in vomit or stool
• Signs of dehydration, such as a lack of wet diapers for 3 hours or more, or a lack of energy
• Forceful vomiting, also called projectile vomiting
• Vomiting with bile, which makes the vomit green or yellow
• Vomiting or regurgitation that begins when a baby is younger than 2 weeks or older than 6 months

If you notice any of these symptoms in your baby, it is important to consult a doctor or pediatrician.

Acid reflux treatment in newborns

Acid reflux, or gastroesophageal reflux (GER), is when food from a baby's stomach travels back up into their oesophagus, which may lead to spitting up or vomiting. This is very common in babies, with around 50% of infants up to 3 months old showing signs of reflux at least once a day. It usually occurs because a baby's digestive tract is not yet fully mature.

In most cases, acid reflux isn't problematic and will go away before a baby's first birthday. However, in some cases, it can be more serious and affect their ability to absorb nutrients. This is known as gastroesophageal reflux disease (GERD) and requires closer monitoring and possibly treatment with medication or, in rare cases, surgery.

If you think your baby might have GERD, you should speak to your paediatrician. They will consider your baby's symptoms and medical history to diagnose or rule out GERD and other possible medical conditions.

If your baby has GER, there are some simple changes you can make to help them spit up less often:

• Burp your baby during and after feedings.
• Keep your baby upright for about 30 minutes after they eat.
• Avoid overfeeding.

If your baby has GERD, your paediatrician may recommend the following treatments:

• Thickened feedings: Adding a thickening agent to breast milk or formula to reduce the symptoms of reflux.
• Feeding pattern changes: Feeding your baby more often but with smaller amounts of milk or formula.
• Removal of cow's milk protein: If your baby is allergic to cow's milk, this could be causing them to spit up and vomit.
• Medication: In some cases, your paediatrician may prescribe medication to manage GERD, such as proton pump inhibitors (PPIs) or H2 blockers.
• Surgery: In rare cases, if other treatments are not effective, surgery may be an option.

Acid reflux causes in newborns

Acid reflux, or gastroesophageal reflux (GER), in newborns is when food from the baby's stomach travels back up into their oesophagus, which may lead to spitting up or vomiting. This is common among babies in their first year and is usually harmless. However, it can sometimes be a sign of gastroesophageal reflux disease (GERD) or other conditions that require medical attention.

The main cause of acid reflux in newborns is the immaturity of the lower oesophageal sphincter, a muscular valve that connects the oesophagus and the stomach. Normally, this muscle relaxes to let food pass from the oesophagus to the stomach and then tightens to prevent food from travelling back up. In newborns, this muscle is not yet fully developed, allowing food and stomach acid to flow back into the oesophagus.

In addition to the underdeveloped lower oesophageal sphincter, there are other factors that can contribute to acid reflux in newborns. One factor is the baby's liquid diet, as liquids are more likely to flow back up than solids. Spending a lot of time lying down can also increase the likelihood of acid reflux, as gravity is not helping to keep the stomach contents in place.

GER can cause symptoms such as spitting up, vomiting, and irritability. In most cases, GER is not problematic and will go away by the time the baby reaches their first birthday. However, in some cases, GER can be more serious and affect the baby's ability to gain weight and grow normally.

If GER persists beyond 12 to 14 months or if the baby is experiencing more severe symptoms, it may be diagnosed as GERD. GERD is a more serious and long-lasting form of acid reflux that can require medical treatment, including medication or, in rare cases, surgery.

Acid reflux diagnosis in newborns

Acid reflux, or gastroesophageal reflux (GER), is a common condition in newborns, affecting around 50% of infants up to 3 months old. It occurs when food from the baby's stomach travels back up into the oesophagus, leading to spitting up or vomiting. While acid reflux is usually harmless and resolves within the first year, it can sometimes indicate a more serious condition, such as gastroesophageal reflux disease (GERD).

Diagnosing Acid Reflux in Newborns:

When it comes to diagnosing acid reflux in newborns, here are the steps that healthcare providers typically follow:

Reviewing Symptoms and Medical History:

• Healthcare providers will first assess the newborn's symptoms, including spitting up, vomiting, coughing, irritability, and poor weight gain. They will also consider the frequency and timing of these symptoms, such as whether they occur after feedings or at night.
• A detailed medical history will be taken, including information on the newborn's birth history, feeding habits, and any family medical conditions.

Physical Examination:

• The newborn will undergo a physical examination to check for signs of medical conditions, particularly those affecting the brain or lungs.
• Measurements of height and weight will be taken to evaluate the newborn's growth and development.

Diagnostic Tests:

• In most cases, acid reflux can be diagnosed based on symptoms and medical history. However, if there is no improvement with feeding changes and anti-reflux medications, or if there are concerns about other health problems, diagnostic tests may be recommended.
• Upper GI series: This test involves the newborn consuming a contrast liquid called barium, which allows healthcare providers to track its movement through the oesophagus and stomach using X-ray images.
• Esophageal pH and impedance monitoring: A thin flexible tube is inserted through the nose into the stomach, measuring the amount of acid or liquid in the oesophagus over a 24-hour period.
• Upper gastrointestinal (GI) endoscopy and biopsy: A long, flexible tube with a light and camera is inserted down the oesophagus, stomach, and small intestine to visually examine these areas and potentially take tissue samples.

Differentiating Between GER and GERD:

• It is important to distinguish between GER and GERD, as they have different levels of severity and treatment approaches.
• GER is typically harmless and resolves within the first year, while GERD can be more chronic and impact the newborn's quality of life, requiring closer monitoring and treatment.

Feeding and Lifestyle Changes:

Before diagnosing GERD, healthcare providers may suggest feeding and lifestyle changes to see if they improve the newborn's symptoms. This includes burping the baby regularly during and after feedings, holding the baby upright during and after feedings, and making changes to the feeding pattern or formula.

Referral to a Specialist:

If the primary healthcare provider is unable to make a definitive diagnosis or if the newborn's symptoms are severe, they may refer the newborn to a paediatric gastroenterologist for further evaluation and specialised care.

Acid reflux prevention in newborns

Acid reflux, or gastroesophageal reflux (GER), is when food from a baby's stomach travels back up into their oesophagus, which may lead to spitting up or vomiting. While it is common among babies in their first year and usually harmless, it can sometimes be a sign of gastroesophageal reflux disease (GERD) or other conditions that require medical treatment.

Burp your baby frequently

Burp your baby during and after feedings. Excess gas in your baby's tummy can cause them to spit up. Burping them regularly can help to avoid this buildup. Make sure to burp bottle-fed infants after every 1 to 2 ounces (or more frequently if they feed less). Burp breastfed babies any time they pull off the nipple.

Keep your baby upright after feedings

Hold your baby upright for at least 20 to 30 minutes after they eat. This can help prevent stomach acids from rising up and causing reflux. However, do not go straight to tummy time after feeding. Always place your baby on their back to sleep.

Avoid overfeeding

Talk to your baby's doctor about how to avoid overfeeding. Your baby's tummy can only hold so much at one time, and overfeeding can increase the risk of reflux. The doctor can help you pace feedings so your baby gets enough nutrition without becoming overly full.

Feeding schedule and formula

Have more frequent feedings with smaller amounts of milk or formula. This can help prevent reflux by reducing pressure on the lower oesophageal sphincter (LES), which is the ring of muscle that prevents food from going back into the oesophagus.

If you are using formula, consider switching to a different type if your baby is sensitive to milk protein. Consult your doctor before making any formula changes.

Sleep position

Avoid using sleep positioners, which are padded risers that keep your baby's head and body in one position. These are not recommended due to the risk of sudden infant death syndrome (SIDS) or suffocation. Instead, always place your baby on their back to sleep on a firm mattress.

Bottle and nipple size

If you bottle-feed, keep the nipple filled with milk throughout the feedings to avoid air gulping. Try using nipples with smaller holes to prevent milk from flowing too fast.

Thicken milk or formula

With your doctor's approval, you may add a small amount of baby cereal to formula or breast milk to make it thicker. This may help reduce spitting up, although there is no evidence that it relieves other reflux symptoms.

Frequently asked questions