Recognizing GERD in Infants

Acid reflux occurs when the contents of the stomach back up into the esophagus. More than half of all infants—and almost 85 percent of premature infants—are estimated to experience acid reflux in the first three months of life. The condition usually peaks at four months and goes away on its own between 12 and 18 months.

It’s rare for symptoms to continue past 24 months. If they persist, it may be a sign of gastroesophageal reflux disease (GERD), which is a more severe condition. While symptoms may vary, here are some of the most common signs of acid reflux or GERD in infants.

Spitting Up and Vomiting

Spitting up is normal for infants. However, spitting up forcefully—especially after meals or past 12 months of age—may be signs of GERD. Spitting up blood, green or yellow fluid, or a substance that looks like coffee grounds may also signify GERD. Spitting up is normally painless. Your baby should still appear happy and healthy. Vomiting is more painful and will be followed by crying and fussing.

Refusal to Eat and Difficulty Eating or Swallowing

Infants with GERD may refuse to eat if they’re experiencing pain during feeding. This pain may come from irritation caused when the contents of the stomach are refluxed into the esophagus.

Irritability During Feeding

Irritability during feeding can display as screaming, crying, and fussiness. It’s usually due to abdominal discomfort or esophageal irritation.

Wet Burps or Hiccups

A “wet burp” or “wet hiccup” is when an infant regurgitates liquid when they burp or hiccup. This can be a sign of GERD.

Failure to Gain Weight

Failure to gain weight may be caused by excessive spitting up or refusal to eat. Normal acid reflux doesn’t usually affect an infant's growth or health. Weight loss or failure to gain weight may be a sign of GERD.

Abnormal Arching

A painful burning sensation caused by stomach fluid that remains in the esophagus may make your infant arch their body, especially during or after feeding. Abnormal arching may appear to be a neurological problem on its own. However, it may be a sign of GERD if it happens in conjunction with other symptoms, such as spitting up or a refusal to eat.

Frequent Coughing or Recurrent Pneumonia

Your infant will cough in response to breathing at the same time regurgitated food reaches the back of the throat. The refluxed material also can be aspirated into the lungs and windpipe, causing chemical or bacterial pneumonia. Your baby can develop other respiratory problems, such as asthma, as a result of GERD.

Gagging or Choking

Refluxed matter going back up into the esophagus may cause your infant to gag or choke. The position of your baby’s body during feeding can make this condition worse. Gravity helps keep the contents of the stomach down. Therefore, it’s best to keep your infant in an upright position at least 30 minutes after feeding to prevent food or milk from being refluxed.

Chest Pain or Heartburn

Regurgitated stomach contents irritate the esophageal lining and causes heartburn when it only goes part way up the esophagus. This symptom may be harder to recognize in infants, but it’s one of the most common signs of acid reflux.

Disturbed Sleep

Your baby might have trouble sleeping as a result of discomfort or irritation caused by acid reflux or GERD. This may be worsened if you feed your baby too close to bedtime, as stomach contents won’t have a chance to settle fully.

It’s important to speak to a physician if you suspect your infant may have GERD. A pediatrician can rule out other conditions or confirm a GERD diagnosis. They can also suggest certain lifestyle changes that may help treat your baby’s GERD or acid reflux.