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Gastroesophageal Reflux in Infants
On this page:
Symptoms
Diagnosis
Treatment
Points to Remember
Hope Through Research
For More Information
Gastroesophageal reflux (GER) occurs when stomach contents come back up into the esophagus (the tube that connects the mouth to the stomach) during or after a meal. A ring of muscle at the bottom of the esophagus opens and closes to allow food to enter the stomach. This ring of muscle is called the lower esophageal sphincter (LES). This sphincter opens to release gas (burping) after meals in normal infants, children, and adults. When the sphincter opens in infants, the stomach contents often go up the esophagus and out the mouth (spitting up or vomiting). GER can also occur when babies cough, cry, or strain. Most infants with GER are happy and healthy even though they spit up or vomit.
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Symptoms
GER occurs often in normal infants. More than half of all babies experience reflux in the first 3 months of life. An infant with GER may experience
spitting
vomiting
coughing
irritability
poor feeding
blood in the stools
Only a small number of infants have severe symptoms due to GER. Most infants stop spitting up between the ages of 12 to 18 months.
In a small number of babies, GER may result in symptoms that are of concern. These include problems such as
poor growth due to an inability to hold down enough food
irritability or refusing to feed due to pain
blood loss from acid burning the esophagus
breathing problems
These problems can be caused by disorders other than GER. Your health care provider needs to determine if GER is causing your child's symptom(s).
Digestive system noting the mouth, esophagus, lower esophageal sphincter (LES), stomach, and small intestine.
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Diagnosis
An infant who spits or vomits may have GER. The doctor or nurse will talk with you about your child's symptoms and will examine your child. If the infant is healthy, happy, and growing well, no tests or treatment may be needed. Tests may be ordered to help determine whether your child's symptoms are related to GER. Sometimes, treatment is started without tests.
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Treatment
The treatment of reflux depends on the infant's symptoms and age. Some babies may not need treatment, because GER often resolves by itself. Healthy, happy babies may only need their feedings thickened with cereal and to be kept upright after they are fed. Overfeeding can aggravate reflux, so your health care provider may suggest different ways of handling feedings. For example, smaller quantities with more frequent feeding can help decrease the chances of regurgitating. If a food allergy is suspected, you may be asked to change the baby's formula, or to modify your diet if you are breastfeeding, for 1 to 2 weeks. If a child is not growing well, feedings with higher calorie content or tube feeding may be recommended.
Speak with your child's health care provider if any of the following occur:
vomiting large amounts or persistent projectile (forceful) vomiting, particularly in infants under 2 months of age
vomiting fluid that is green or yellow in color or looks like coffee grounds or blood
difficulty breathing after vomiting or spitting up
excessive irritability related to feeding, or refusing food, which seems to cause weight loss or poor weight gain
difficult or painful swallowing
Other treatments include the following:
When a child is uncomfortable, has difficulty sleeping or eating, or does not grow, the doctor or nurse may suggest a medication. Different types of medicine can be used to treat reflux by decreasing the acid secreted by the stomach. One class of medications, called H2-blockers, includes cimetidine (Tagamet), ranitidine (Zantac), famotidine (Pepcid), and nizatidine (Axid). Another type of medication is the proton-pump inhibitors, such as esomeprazole (Nexium), omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex), and pantoprazole (Protonix).*
Very rarely infants have severe GER that prevents them from growing or causes breathing problems. In some of these infants, surgery may be the best option.
Your child's doctor or nurse will discuss GER with you and suggest treatment if needed. The potential complications of the medications will be explained. Most infants don't need medications and will outgrow reflux by 1 or 2 years of age.
* The authors of this fact sheet do not specifically endorse the use of drugs for children that have not been tested in children ("off label" use). Such a determination can only be made under the recommendation of the treating health care provider.
Specific Instructions for Infants With GER
If the baby is bottle fed, add up to one tablespoon of rice cereal to 2 ounces of infant milk (including expressed breast milk). If the mixture is too thick for your infant to take easily, you can change the nipple size or cross cut the nipple.
Burp your baby after 1 or 2 ounces of formula are taken. For breastfed infants, burp after feeding on each side.
Do not overfeed. Talk to your child's doctor or nurse about the amounts of formula or breast milk that your baby is taking.
When possible, hold your infant upright in your arms for 30 minutes after feeding.
Infants with GER should usually sleep on their backs, as is suggested for all infants. Rarely, a physician may suggest other sleep positions.
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Points to Remember
GER occurs when stomach contents back up into the esophagus.
GER is common in infants but most children grow out of it.
In infants, GER may cause spitting up, vomiting, coughing, poor feeding, or blood in the stools.
Treatment depends on the infant's symptoms and age, and may include changes in eating and sleeping habits. Medication may also be an option, or surgery in severe cases.
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Hope Through Research
The National Institute of Diabetes and Digestive and Kidney Diseases, through its Division of Digestive Diseases and Nutrition, supports basic and clinical research into gastrointestinal diseases. Researchers are studying the risk factors for developing GER and what causes the LES to open, with the aim of improving future treatment for GER.
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For More Information
North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition
Phone: 1-888-344-8888
Internet: www.NASPGHAN.org
www.CDHNF.org
www.KidsAcidReflux.org
www.TeensAcidReflux.org
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The U.S. Government does not endorse or favor any specific commercial product or company. Trade, proprietary, or company names appearing in this document are used only because they are considered necessary in the context of the information provided. If a product is not mentioned, this does not mean or imply that the product is unsatisfactory.
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This information was prepared in partnership with the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN), the Children's Digestive Health and Nutrition Foundation (CDHNF), and the Association of Pediatric Gastroenterology and Nutrition Nurses (APGNN). The information is intended only to provide general information and not as a definitive basis for diagnosis or treatment in any particular case. You should consult your child's doctor about your child's specific condition.
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National Digestive Diseases Information Clearinghouse
2 Information Way
Bethesda, MD 20892-3570
Email: nddic@info.niddk.nih.gov
The National Digestive Diseases Information Clearinghouse (NDDIC) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK is part of the National Institutes of Health under the U.S. Department of Health and Human Services. Established in 1980, the clearinghouse provides information about digestive diseases to people with digestive disorders and to their families, health care professionals, and the public. NDDIC answers inquiries, develops and distributes publications, and works closely with professional and patient organizations and Government agencies to coordinate resources about digestive diseases.
Publications produced by the clearinghouse are carefully reviewed by both NIDDK scientists and outside experts. This fact sheet was reviewed by NASPGHAN.
This e-text is not copyrighted. The clearinghouse encourages users of this e-pub to duplicate and distribute as many copies as desired.
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NIH Publication No. 04-5419
December 2003
http://digestive.niddk.nih.gov/ddiseases/pubs/gerdinfant/index.htm
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