Acid reflux happens when the contents of the stomach back up into the esophagus. The esophagus is the tube that carries food from the throat to the stomach. At the bottom of the esophagus, where it joins the stomach, is a ring of muscle that normally opens for limited amounts of time when you swallow. This ring of muscle is known as the lower esophageal sphincter (LES). When the LES doesn’t close completely, stomach contents and digestive juices can come back up into the esophagus.

Infants are more susceptible to acid reflux because their LES may be weak or underdeveloped. In fact, it’s estimated that more than half of all infants experience acid reflux to some degree. The condition usually peaks at 4 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 and symptoms of acid reflux or GERD in infants.

Spitting up and Vomiting

Spitting up is normal for infants. However, forceful spit up may be a symptom of GERD. This is especially true if your infant is over 12 months old and still spitting up forcefully after meals. 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 after spitting up. Forceful spitting up or vomiting is more painful and will be followed by crying and fussing.

Refusal to Eat and Difficulty Eating or Swallowing

Your infant may refuse to eat if they’re experiencing pain during feeding. This pain might be due to the irritation that occurs when the contents of the stomach come back up into the esophagus.

Irritability During Feeding

Infants with GERD may also start screaming and crying during feeding. It’s usually due to abdominal discomfort or esophageal irritation.

Wet Burps or Hiccups

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

Failure to Gain Weight

Weight loss or failure to gain weight may occur as a result of excessive spitting up.

Abnormal Arching

Infants may arch their body during or after feeding due to a painful burning sensation caused by the buildup of stomach fluid in the esophagus. Abnormal arching may be a neurological problem on its own. However, it can be a symptom of GERD if your baby is also spitting up or refusing to eat.

Frequent Coughing or Recurrent Pneumonia

Your infant may cough frequently, causing food to come back up into the back of the throat. The regurgitated food can also be inhaled into the lungs and windpipe, which may lead to chemical or bacterial pneumonia. Other respiratory problems, such as asthma, can also develop as a result of GERD.

Gagging or Choking

Your baby may gag or choke when stomach contents flow back up into the esophagus. The position of your baby’s body during feeding can make this condition worse. Gravity helps keep the contents of the stomach down. It’s best to keep your infant in an upright position for at least 30 minutes after feeding to prevent food or milk from coming back up.

Chest Pain or Heartburn

Regurgitated stomach contents may irritate the esophageal lining and cause heartburn. This is one of the most common signs of acid reflux, but it may be hard to recognize in infants.

Disturbed Sleep

Infants with GERD can experience discomfort or irritation due to reflux, which may make it more difficult for them to sleep through the night. Try to feed your baby well before bedtime so stomach contents have a chance to settle fully.

It’s important to speak with your doctor or pediatrician if you suspect your infant has GERD. Your doctor 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.