Many new parents are surprised by how often their baby spits up. It's natural to wonder if it's bad for them or if spitting up regularly could be harmful or painful. The good news is that it's usually nothing to worry about.
In fact, it's common for healthy babies to spit up after eating because their digestive systems aren't fully developed. This condition—known as acid reflux or gastroesophageal reflux (GER)—rarely causes problems for babies, and it usually resolves on its own by 12 to 18 months. Acid reflux accompanied by other symptoms, on the other hand, may point to another problem such as gastroesophageal reflux disease (GERD).
Learn more about acid reflux in babies, including causes, symptoms, and remedies.
Causes of Acid Reflux in Babies
Some babies spit up more than others, but all babies do it to some degree. This happens because a newborn's gastrointestinal system (particularly the lower esophageal sphincter) is still developing. Babies have small stomachs that fill quickly with breast milk, formula, and/or air. When their tummies reach or pass capacity, the valve holding their food in the stomach can give way. This is completely normal in babies.
Excess stomach contents travel back up the esophagus and out of the mouth, leading to spitting up or vomiting. Acid reflux is common among healthy babies, and unless it interferes with feeding or well-being, parents should have little cause for concern.
Premature babies and those with certain conditions, such as those that affect the lungs or nervous system like cerebral palsy or cystic fibrosis, are more prone to acid reflux and are more likely to need treatment.
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Signs of Acid Reflux in Babies
Babies who regularly spit up but are otherwise healthy most likely have acid reflux, while those with more severe symptoms may have GERD. If your baby exhibits the following symptoms, they may be experiencing acid reflux:
Spitting up and vomiting. Although all babies spit up occasionally, those with GERD may do so more often or forcefully.Poor feeding. Since chronic acid reflux can irritate the esophagus (heartburn), your baby might not eat normally. They might arch their back and retract from the nipple while nursing or bottle feeding.Fussiness. Babies with acid reflux may act irritable or fussy after feedings.Breathing issues. Babies with reflux may cough, wheeze, and experience congestion when stomach acid gets into the upper airways. These symptoms may worsen when your little one lies flat.Hiccups. Hiccups and wet burps are more prevalent in babies with reflux. They're caused by excess air in the belly and esophageal irritation.
Acid reflux or gastroesophageal reflux (GER) progresses to GERD when the frequency or severity of symptoms are more pronounced. GERD is more bothersome to the baby and can cause health problems, such as poor weight gain.
Could It Be GERD?
If acid reflux is severe, your baby might have gastroesophageal reflux disease (GERD)—especially if symptoms last past 12 to 14 months of age. Besides the symptoms listed above, other signs of GERD include failure to gain weight, trouble sleeping, frequent vomiting, and respiratory problems like recurring pneumonia or wheezing. Some babies with GERD may also display symptoms of colic (unexplained crying for more than three hours a day, more than three days per week). Talk to a pediatrician if you suspect GERD.
When Does Acid Reflux in Babies Go Away?
According to Alan Greene, MD, FAAP, the peak age for reflux is around 4 months, and most babies outgrow it by 7 months old. That's when the esophageal sphincter muscle develops enough to close properly and keep the stomach contents where they belong. It's rare for babies to have acid reflux after 18 months of age.
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Natural Remedies for Acid Reflux in Babies
Typically, acid reflux doesn't cause any distress or harm for babies. So, in most cases, no treatment is needed. However, some babies experience discomfort or feeding issues relating to acid reflux. For babies who show signs of irritation, consider these natural remedies for this digestive problem.
Breastfeed or try a different formula
Breast milk is the recommended choice for babies with acid reflux since it is digested about twice as fast as formula. If breastfeeding isn't feasible or desired, talk to a health care professional about which formula is best for your baby. Sometimes switching to a hypoallergenic or lactose-free option can help relieve symptoms.
Keep your baby upright after feeding
Keeping your baby in an upright sitting position during feedings—and for at least 20 minutes afterward—can prevent food from traveling upward into the esophagus.
Give frequent but small feedings
Feeding your baby smaller meals will be easier on their stomach and also decrease reflux because there's less to regurgitate. Some babies with reflux naturally prefer to eat this way; others get cranky if they don't get their full feeding right away. After a few days, though, your baby should adjust to this new schedule, so try to stick with it. Just remember to feed them more often if you reduce the quantity given at each meal.
Burp often
Burping regularly can reduce acid reflux symptoms. Aim to pause feeding every five minutes or 2 to 3 ounces to burp your baby. Burping will release gas and relieve the symptoms of reflux. Burping also makes more space in the stomach for breast milk or formula, which makes spitting up less likely.
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Delay playtime after meals
Avoid jostling or bouncing your baby right after a feeding. All that movement increases the likelihood of spitting up or vomiting.
Avoid tight diapers and clothing
Tight clothing or diapers around the middle can put added pressure on a baby's tummy and make them especially irritable. Dressing them in looser clothing and fastening their diaper with a bit of breathing room can reduce the severity of symptoms.
Change your diet
Consider eliminating gas-producing foods from your diet if breastfeeding. Some foods, such as dairy products or vegetables like cabbage, garlic, or onions, may increase baby acid reflux.
Check nipple size
A bottle-fed baby may swallow too much air if the nipple is too small or big. Excess air in the tummy can make spitting up more prevalent as it leaves less room in the stomach for food.
Thicken your baby's milk
Some pediatricians recommend adding some rice cereal to formula or expressed milk for babies who are a few months old or older to make it easier to digest and reduce symptoms of GER or GERD. Thickening the milk will also slow down your baby's intake. Always talk to a health care professional before trying this method if your baby is under 6 months old since rice cereal may be harder to swallow, adds extra calories, and changes the nutritional makeup of your baby's diet.
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Medical Treatment for Acid Reflux in Babies
In all but rare cases, acid reflux in babies will go away with time and may be relieved with natural remedies. However, if your baby's reflux isn't improving—or is getting worse—talk to a pediatrician about possible treatments, such as a prescription medication or surgery to relieve the symptoms. According to Dr. Greene, “Usually we only use the medication if the child is not growing well, has a chronic cough or trouble breathing, or seems to be in pain—not for just spitting up.”
While no drug is free from side effects, rest assured that many of the most common drugs given for acid reflux are very safe and effective. And since most babies outgrow acid reflux before their first birthday, they usually don't need to take the meds for very long.
Acid reducers like Zantac (ranitidine) are usually the first choice, while proton pump inhibitors like Prevacid (lansoprazole) and Prilosec (omeprazole) are reserved for more severe cases. According to Dr. Greene, "Zantac is a medicine that decreases the acidity of what sloshes up. Whether the benefits outweigh the possible side effects depends on how severe the symptoms are."
Key Takeaways
Most babies spit up with some regularity, particularly in the first 6 months of life. This problem, called acid reflux or gastroesophageal reflux (GER), is caused by an underdeveloped digestive system. It is not harmful and babies typically grow out of it by the time they reach 12 to 18 months old without intervention. In the rare cases that GER progresses to gastroesophageal reflux disease (GERD), treatments are available to reduce the severity of symptoms. Consult with your baby's pediatrician if you have concerns about spitting up or other feeding issues.
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