Reflux in babies: Signs, symptoms, and treatment options

It’s uncomfortable for baby — and really, really common — but it’s no reason to stop breastfeeding. Here’s what you need to know about reflux in babies

Yes, babies cry and spit up, and even tend to have some digestive issues as their little systems mature. But if the crying is constant, the spit up is excessive and the digestive issues are making them (and you) miserable, there may be something else going on. While we hear a lot about baby sleep techniques and the latest teething toys, reflux is a topic that’s not as widely discussed, even though many babies suffer from reflux. Here are the signs to look for so you can get help from a pediatrician sooner than later.

Standard signs and symptoms of reflux:

• Excessive or frequent spit up — like after almost every feeding, hours between feedings or a significant volume
• Arching back or crying during or after feedings
• A raspy or congested sound in the baby’s throat
• Gagging or coughing
• Refusal to feed (because of the pain) OR wanting to feed very frequently or for long periods (to soothe the burn of acid)
• Slow or no weight gain/growth

Be aware that there’s also something called “silent” reflux. This is when a baby doesn’t actually expel any spit up, but acid travels up their esophagus and irritates it.

Reflux or colic?

Colic and reflux can both keep a baby on edge, but they have very different symptoms. To distinguish between the two, timing is key: Colic-related irritability is more likely to surface in the afternoon, and if your baby does get agitated, it will be easy to calm her down. Reflux is more likely to follow feedings, and can bring sharp cries of pain — distinct from colicky cries of frustration — at random times throughout the day. Babies with reflux won’t be as easily soothed as babies with colic. If you’re not sure whether your infant has reflux or colic, connect with a lactation consultant (IBCLC) or pediatrician just to be sure.

Potential causes

Reflux is pretty common for babies because they’re eating an all-liquid diet and lying down most of the time. (Let’s all think back to those last weeks of pregnancy and what happened when we tried to go to bed after a big dinner: Heartburn, reflux, and vowing never to eat another bite of salsa.) Plus, babies are often born with a little maturing left to do. The muscle between their esophagus and stomach (the lower esophageal sphincter) can be a bit immature and allow milk to flow back up. This is why reflux is especially common in premature babies. Another possible cause is a food intolerance or allergy, often to cow’s milk protein, so sadly, your nightly bowl of ice cream could be behind your baby’s reflux flares. In rare cases, pyloric stenosis, a muscular blockage between the stomach and small intestine, or eosinophilic esophagitis (EoE), a chronic immune system disease, can be to blame.

Home and lifestyle remedies

If you suspect your baby has reflux, you can do a few simple things to help prevent and relieve their symptoms. Position them upright for 20 to 30 minutes after feedings (here’s where you can put that new wrap or carrier to good use). You can also experiment with more upright nursing positions. Try smaller, more frequent feedings and stop often to burp baby. And if spit up is a main symptom, be prepared for lots of laundry! Stock up on bibs and burp cloths, and always have a change of clothes handy for your baby and yourself (yes, an extra shirt will become a must-have).

Diet changes

Because food intolerances or allergies can cause reflux, changes to your diet may help ease your baby’s symptoms. Cow’s milk protein (not the lactose, but the protein in dairy products) is the most common issue, but if you’re not sure what the problem food is, start jotting down what you eat and when. Over time, you may be able to spot a pattern and draw a connection between the foods you eat and your baby’s reflux flare-ups. For babies who are sensitive to dairy, many also have problems with soy. Food intolerances and allergies sometimes also cause other symptoms like eczema, rashes, or mucus in the baby’s stools, so if you see these in addition to reflux, a diet change might be the solution you need. Call your pediatrician to discuss these irregularities.

Medical support

Moms are well-equipped to notice changes in their baby’s temperament, which can be the earliest indication of reflux. If you’ve tried making lifestyle and diet changes and something still feels off, talk to your pediatrician to get a more concrete diagnosis. You may have a “happy spitter” — a baby who’s not terribly upset by reflux — in which case, they may not recommend anything besides doing a lot of laundry. But in other cases, your pediatrician may refer you to a pediatric gastroenterologist (GI) or prescribe a medication like an H2 blocker (usually Zantac) or proton-pump inhibitor PPI (such as Prevacid). You may need to try a couple different types and adjust the dosage before you find what works best, but many moms find that giving medication on a short-term basis makes a huge difference in their baby’s symptoms.

A lactation consultant (IBCLC) can help

While you’re in the midst of it, dealing with reflux can feel frustrating and heartbreaking. But the good news is that reflux usually improves once babies can sit up and then often ends by the time they start walking. If your baby’s reflux is caused by a food intolerance, many babies outgrow their intolerances, often by their first birthday. So hang in there and ask for support from an International Board Certified Lactation Consultant (IBCLC) — it gets better.