Acid reflux is a condition in which stomach contents and acid flow back up into the throat and esophagus. The esophagus is the tube that connects the throat and stomach. It’s a common problem in infants, especially those who are three months old or younger. Acid reflux usually occurs when the lower esophageal sphincter (LES) is weak or underdeveloped. The LES is the muscle between the stomach and the esophagus. It’s typically a one-way valve that temporarily opens when you swallow something. When the LES doesn’t close properly, stomach contents can flow back into the esophagus. Acid reflux can also result from a hiatal hernia or food allergies.

A normal, healthy infant who has mild acid reflux may spit up after feedings, but usually isn’t irritable. They likely won’t experience acid reflux after reaching 12 months of age. In some infants, however, acid reflux can be severe.

Signs of a severe reflux problem in infants include:

  • crying and irritability
  • little to no weight gain
  • refusal to eat
  • stools that are bloody or look like coffee grounds
  • frequent or forceful vomiting
  • vomit that is yellow, green, bloody, or looks like coffee grounds
  • wheezing or coughing
  • difficulty breathing
  • apnea (absence of breathing)
  • bradycardia (slow heart beat)

It’s rare for infants to have severe symptoms of acid reflux. However, you should call your doctor immediately if your child is experiencing any of these symptoms. They may indicate a serious condition that needs to be treated right away.

Treatment for acid reflux in infants will depend on the severity of the condition. In most cases, however, your doctor will want you to a change the way you feed your baby. They may occasionally recommend making adjustments to your baby’s formula if your baby takes formula. Don’t change your baby’s formula or stop breastfeeding without talking to your doctor.

Mild Acid Reflux

Your doctor may recommend adding one to two teaspoons of rice cereal to the formula if your infant has mild, recurring episodes of acid reflux. The thickened formula will make the stomach contents heavier and harder to regurgitate, which means they’re less likely to come back up.

It’s important to note that even though this helps reduce the amount of vomiting, it doesn’t stop acid reflux completely. Also, adding rice cereal to the formula before an infant is four months old can increase the risk of food allergies or other complications, such as overfeeding or choking. Don’t add cereal to your infant’s formula unless your doctor tells you to do so.

Severe Acid Reflux

Your doctor may recommend a change in formula if your baby has severe acid reflux. Most infant formulas are made from cow’s milk and fortified with iron. Some infants are allergic to a protein found in cow’s milk, which can trigger their acid reflux. This makes it necessary to find another type of formula for your baby.

Hydrolyzed Protein Formulas

Hydrolyzed protein formulas are made from cow’s milk with ingredients that are easily broken down for better digestion. These formulas are the most effective in reducing acid reflux, so they’re often recommended for infants with food allergies. Your doctor may want you to try this type of formula for a couple of weeks if food allergies are suspected. These formulas are more expensive than regular formulas.

Soy Milk Formulas

Soy milk formulas don’t contain any cow’s milk. They’re usually only recommended for infants with lactose intolerance or galactosemia. Lactose intolerance is the inability to process a type of sugar called lactose. Galactosemia is a disorder that makes it very hard for the body to break down a simple sugar called galactose. Both of these sugars are found in cow’s milk. Soy formulas aren’t recommended for premature babies, as they can affect bone development. There’s also some concern about the higher amount of aluminum in soy formulas and the possible hormonal or immune effects on infants. Soy formulas also usually cost more than cow’s milk formulas.

Specialized Formulas

Specialized formulas are created for infants with diseases or certain medical conditions, such as premature birth. Ask your doctor which formula your baby should be taking if they have a special condition.

Other Recommendations

It’s a good idea to keep these recommendations in mind while feeding your baby, regardless of the cause of acid reflux:

  • Burp your baby more often (usually after one to two ounces of formula).
  • Avoid overfeeding.
  • Feed your child smaller portions more frequently.
  • Keep your baby in an upright position for 20 to 30 minutes after feeding.
  • Don’t jostle your child after feeding. This can cause the stomach contents to come back up.
  • Wait 30 minutes after feeding before putting your child to sleep.
  • Consider trying different sizes of bottle nipples or even different types of bottles when bottle-feeding.

Although acid reflux can cause some discomfort in your child, it is a treatable condition. You can help manage your baby’s acid reflux by changing their formula and making adjustments to the way you feed them. However, if your baby has severe reflux or isn’t improving with feeding adjustments, talk to your doctor about medications or other treatment options.