Gastroesophageal reflux, or GER, is when food leaves the stomach and travels back up the esophagus (food tube). All babies have some GER because the sphincter muscle that keeps the food down in the stomach is less effective in babies. Of course, some infants do this more than others.

  There is a spectrum of GER in babies ranging from asymptomatic infants who just have a little breast milk or formula come slightly up the esophagus, to infants who spit up with every feeding. Therefore, we need a way to decide which infants require further intervention, and which are just messy! By the way, when GER requires further intervention we sometimes refer to it as gastroesophageal reflux disease, or GERD.

  Basically, there are three factors which would lead us to want to do something about an infant’s GER. One is if they are not growing well enough. This would be evident by looking at the growth chart. A second factor would be if the GER is causing respiratory symptoms. These might include chronic cough, wheezing, brief pauses in breathing, or occasionally, aspiration pneumonia (although this is rare). Another symptom leading to treatment of GER in an infant would be if it is causing pain. Of course this can be somewhat confusing because the babies don’t come right out and tell us they have heartburn. Sometime they will just cry or fuss after meals. Others will arch their backs after eating.

  As you may have guessed, it can be difficult to tell if any of these symptoms are coming from GERD, or from something else. Unfortunately, there are not any quick and easy things that allow us to discern this. Often it comes down to simply trying an intervention to see if it helps. Other times we may need to resort to tests such as an upper GI barium contrast study to look at the anatomy of the GI tract, or a pH probe study to try to determine if GERD is the cause.

  When we do intervene in a baby whom we feel has GERD, we usually start with the least invasive options unless the symptoms are severe. These may include things as simple as raising the head of the crib to a slight angle to let gravity help keep food down. We may also want to maximize ‘burping’ the infant so that the gas is not pushing the fluids back up the esophagus. Sometimes we will ask that you thicken infant formula with cereal in an attempt to prevent GERD. If these simple interventions fail, we may decide to try medications that block acid production in the stomach or empty the stomach faster. In a worst case scenario, there are surgeries available which can stop severe GERD.

  In summary, most babies who spit up just cause extra laundry, and fortunately the problem tends to resolve itself with time; however, if you suspect that your infant seems to be having trouble due to GERD, let us know.

Reviewed by: Nathan Landefeld, MD, FAAP