Recognizing Acid Reflux/GERD in Infants

Medically reviewed by Karen Gill, MD on July 3, 2017Written by Tayla Holman

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 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 prone 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 age 4 months and goes away on its own between 12 and 18 months of age.

It’s rare for an infant’s 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 they may vary, the 10 most common signs of acid reflux or GERD in infants include:

  1. spitting up and vomiting
  2. refusal to eat and difficulty eating or swallowing
  3. irritability during feeding
  4. wet burps or hiccups
  5. failure to gain weight
  6. abnormal arching
  7. frequent coughing or recurrent pneumonia
  8. gagging or choking
  9. chest pain or heartburn
  10. disturbed sleep

1. 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 older than 12 months 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 or other, more serious disorders.

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.

2. Refusal to eat and difficulty eating or swallowing

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

3. Irritability during feeding

Infants with GERD may also start screaming and crying during feeding. The response is usually due to abdominal discomfort or esophageal irritation.

4. 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 acid reflux or, less commonly, GERD.

5. Failure to gain weight

Weight loss or failure to gain weight may occur as a result of excessive vomiting or poor feeding associated with acid reflux or GERD.

6. Abnormal arching

Infants may arch their body during or after feeding. It’s thought that this may be due to a painful burning sensation caused by the buildup of stomach fluid in the esophagus. Abnormal arching may be a neurologic problem on its own. However, it can be a symptom of GERD if your baby also spits up or refuses to eat.

7. Frequent coughing or recurrent pneumonia

Your infant may cough frequently due to acid or food coming 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 develop as a result of GERD as well.

8. Gagging or choking

Your baby may gag or choke when stomach contents flow back into their esophagus. The position of your baby’s body during feeding can make it 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 them to prevent food or milk from coming back up.

9. 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 in older children and adults, but it may be hard to recognize in infants.

10.  Disturbed sleep

GERD and reflux can make it more difficult for your baby to sleep through the night. Try to feed your baby long before bedtime so stomach contents have a chance to settle fully. There are other ways to help your baby sleep, too.

It’s important to speak with your doctor or pediatrician if you think 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.

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