Acid reflux, a regurgitation of stomach contents, is a common problem in infants—especially those who are three months or younger. The usual cause is a weak and or under-developed lower esophageal sphincter (the muscle between the stomach and the esophagus) that allows stomach contents to flow back into the esophagus. Reflux can also result from a hiatal hernia or food allergies.
A normal, healthy infant who experiences acid reflux may spit up after feedings, but usually isn’t irritable and won’t experience reflux after reaching 12 months of age. However, in some infants, acid reflux can be severe.
Signs of a severe reflux problem in infants include:
- crying and irritability
- poor weight gain or refusal to eat
- stools that are bloody or look like coffee grounds
- wheezing or hoarseness
- apnea (absence of breathing) and bradycardia (slow heart beat)
According to the American Academy of Pediatrics, less than one percent of infants have severe symptoms of acid reflux. When they do, immediate care is required.
If your baby has occasional or severe acid reflux, your pediatrician may request a change in the way you feed them. As the reasons for acid reflux vary, so do the treatments.
Mild Acid Reflux
Your pediatrician may recommend adding one to two teaspoons of rice cereal to the formula to thicken it if your infant has mild, recurring bouts of acid reflux. This makes the contents of the stomach stay down because it’s heavier and not as easy to regurgitate. However, research has shown that while this helps reduce the amount of vomiting, it doesn’t resolve the occurrence of gastrointestinal reflux.
Also, adding rice cereal to formula before an infant is four months old can lead to food allergies or other complications, such as overfeeding or choking. Don’t add cereal to your infant’s formula unless directed by your pediatrician.
Severe Acid Reflux
For severe acid reflux, your pediatrician may recommend a change in formula. Most infant formulas are made from cow’s milk and are fortified with iron. Some infants’ severe acid reflux is due to food allergies, making alternative options necessary.
Hydrolyzed Protein Formulas
Hydrolyzed formulas are made from cow’s milk with ingredients that are easily broken down for easy digestion. These formulas are the most effective in reducing acid reflux and are often recommended for infants with food allergies. If food allergies are suspected, your pediatrician may have you try this type of formula for a two to four week trial.
Soy Milk Formulas
Soy milk formulas contain no cows’ milk. They’re recommended for infants with lactose intolerance or galactosemia, a condition in which the infant is unable to break down the two sugars found in milk. According to the American Academy of Pediatrics, soy formulas should only be used for lactose intolerant infants or those with galactosemia, as the nutrients in soy are more difficult to break down and absorb.
Specialized formulas are created for infants with diseases or special conditions, such as premature birth. Check with your pediatrician about the formula that your infant should be taking if they have a special medical condition.
It’s a good idea to keep these recommendations in mind during feeding, no matter the cause of acid reflux. For example:
- Burp your baby more often (usually after one to two ounces of formula).
- Avoid overfeeding.
- Feed your infant smaller portions more frequently.
- Keep your baby in an upright position after feeding.
- Don’t jostle the baby after feeding, as this can cause the stomach contents to reflux.
- Wait 30 minutes after feeding before putting the infant to sleep, as positioning can affect reflux symptoms.