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Reflux in Infants
Reviewed by Medicinsk Expert•Last updated: 2026-10-22•Digestive System

Reflux in Infants

Reflux in infants is a common condition where stomach contents flow back into the esophagus, but it typically resolves as a baby grows and develops.

What is reflux (GER) and GERD?

Gastroesophageal reflux (GER), often called reflux or spitting up, happens when food or milk comes back up from your baby's stomach into the esophagus. The esophagus is the tube that carries food from your mouth to your stomach. Reflux is very common in healthy babies. It usually starts to get better by 6 months of age and goes away by 12 months. Reflux that continues after 18 months is unusual.

Gastroesophageal reflux disease (GERD) is a more serious and long-lasting type of reflux. It can cause feeding problems, discomfort, or other symptoms that affect your baby's growth or sleep. Babies may have GERD if symptoms prevent them from feeding well or last longer than 12 to 14 months.

What causes reflux and GERD in infants?

There is a muscle (the lower esophageal sphincter) that acts as a valve between the esophagus and stomach. When your baby swallows, this muscle relaxes to let food pass from the esophagus to the stomach. This muscle normally stays closed, so the stomach contents don't flow back into the esophagus.

In babies who have reflux, this muscle is not fully developed and lets the stomach contents back up the esophagus. This causes your baby to spit up (regurgitate). As your baby grows and the sphincter muscle fully develops, your baby should no longer spit up.

In babies who have GERD, the sphincter muscle becomes weak or relaxes when it shouldn't. This allows stomach contents to come up more often or cause irritation.

How common are reflux and GERD in infants?

Reflux is very common in babies and usually goes away on its own. Most babies spit up several times a day during their first 3 months. They usually stop spitting up between the ages of 12 and 14 months.

GERD is less common. Babies may show symptoms, but they decrease with growth, with only a small number of babies affected by 12 months.

Babies are more likely to have reflux or GERD if they:

  • Were born too early (premature)
  • Have lung problems, such as cystic fibrosis
  • Have conditions that affect the nervous system, such as cerebral palsy
  • Have a hiatal hernia (when part of the stomach pushes up into the chest)
  • Have had surgery on the esophagus

What are the symptoms of reflux and GERD in infants?

In babies, the main symptom of reflux and GERD is spitting up. GERD may also cause symptoms such as:

  • Arching of the back, often during or right after eating
  • Coughing
  • Gagging or trouble swallowing
  • Irritability or crying, especially after eating
  • Poor eating or refusing to eat
  • Not gaining enough weight or losing weight
  • Wheezing or trouble breathing
  • Forceful or frequent vomiting

Other conditions can cause similar symptoms. Contact your baby's health care provider if your baby has symptoms, especially if your baby isn't gaining weight.

How are reflux and GERD diagnosed in infants?

In most cases, your provider diagnoses reflux by reviewing your baby's symptoms and medical history. Testing is only needed if symptoms don't get better with feeding changes or medicines, or if there are other health concerns.

Several tests can help your provider diagnose GERD:

  • Upper GI series: Looks at the shape of your baby's upper GI tract using x-rays and a barium liquid.
  • Esophageal pH or impedance monitoring: Measures the amount of acid or liquid in your baby's esophagus over 24 hours using a thin, flexible tube.
  • Upper gastrointestinal (GI) endoscopy and biopsy: Uses an endoscope to view the esophagus, stomach, and small intestine, and may include taking tissue samples.

What feeding changes can help treat my infant's reflux or GERD?

Simple feeding changes may help reduce your baby's reflux:

  • Add rice cereal to your baby's bottle of formula or breastmilk, as directed by your provider.
  • Burp your baby after every 1 to 2 ounces of formula or after nursing from each breast.
  • Avoid overfeeding; give your baby the recommended amount of formula or breast milk.
  • Hold your baby upright for 30 minutes after feedings.
  • If your provider suspects a milk protein sensitivity, they may suggest switching formulas.

What are the treatments for my infant's GERD?

If feeding changes do not help enough, your provider may recommend medicines to reduce stomach acid. These are only suggested if your baby still has regular GERD symptoms and has trouble sleeping, feeding, or gaining weight. Surgery is rarely needed and is only considered if reflux causes serious breathing problems or significant weight loss.

Frequently Asked Questions

happy spitter has physiologic gastroesophageal reflux (GER), meaning they spit up milk frequently but continue to gain weight well, feed eagerly, and show no prolonged distress or crying during or after feedings. In contrast, an infant with gastroesophageal reflux disease (GERD) experiences complications such as poor weight gain or weight loss, intense crying or back arching during feeds, food refusal, chronic coughing, or recurrent respiratory issues due to stomach acid irritating the esophagus.
Keep your baby in an upright position for 20 to 30 minutes after each feeding, avoiding immediate tummy time or sitting in slouching car seats. Feed smaller volumes more frequently to prevent overfilling the stomach, and burp your baby every one to two ounces during bottle feeds or when switching breasts. If bottle feeding, ensure the nipple size prevents excessive air swallowing. Avoid tight diapers or clothing that puts pressure on the infant's abdomen.
Contact a pediatrician or seek emergency care immediately if spit-up is green or bright yellow (bilious), projectile or forcefully expelled across a room, contains blood or dark brown flecks, or is accompanied by severe lethargy, fever, or signs of dehydration such as fewer than four wet diapers in 24 hours and sunken eyes. Projectile vomiting in infants between 2 and 8 weeks of age may signal pyloric stenosis, a condition requiring urgent surgical correction.
Pediatricians generally reserve acid reducers, such as histamine H2-receptor antagonists or proton pump inhibitors, for infants with confirmed GERD who exhibit visible signs of esophageal inflammation (esophagitis), failure to gain adequate weight, or severe pain that does not improve after non-medical adjustments. These medications reduce stomach acidity to allow esophageal healing, but they do not stop the physical backflow of milk and can slightly increase the risk of intestinal or respiratory infections.
Source: MedlinePlus, National Library of Medicine

MedlinePlus brings together authoritative health information from the National Library of Medicine (NLM), the National Institutes of Health (NIH), and other government agencies and health-related organizations.

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