What causes reflux?
A baby may have reflux when her esophageal sphincter (the valve connecting the esophagus to the stomach) is weak or not working properly. This allows food and gastric juices to flow back up out of her stomach and into her mouth. It’s also what causes heartburn in adults.
How is GERD diagnosed and treated?
The doctor will examine your baby and ask you to describe the symptoms. To reduce the reflux, she'll likely suggest a few things you can try at home. These may include keeping the baby upright after feedings; giving him smaller, more frequent meals; burping him more frequently; and thickening the milk or formula with rice cereal. (See more about these techniques below.)
She may also suggest eliminating cow's milk from your diet if you're breastfeeding or switching to a hypoallergenic formula, because the reflux symptoms can be caused by an intolerance of certain milk proteins.
If these measures don't work, she may prescribe medication. Some babies respond right away to antacids or acid blockers. (But never give these medications to your baby without consulting a doctor.) Your baby may be on the medication for a few months.
If these medications don't help, the doctor might do further tests or refer you to a gastroenterologist to be sure that GERD is the problem.
The tests may include X-rays of the upper gastrointestinal tract. (This is called an upper GI series.) Your baby will have to drink a chalky substance called barium beforehand. The X-rays will show whether there are any anatomic problems that could affect swallowing.
The doctor might also do a “scope” of the digestive tract, including taking some biopsies (small tissue samples). This is an inpatient procedure in which the baby is sedated and a tiny camera is threaded down through the esophagus, stomach, and sometimes small intestines to see if there's any inflammation or damage to the tissues.
Another test your baby may have is a 24-hour pH probe study. In this procedure, he's checked into the hospital overnight and a very thin tube is threaded through the nose down to the base of his esophagus and monitored for 24 hours. This test measures the frequency and severity of reflux episodes as well as the baby's breathing and heart rate.
If your baby continues to spit up a lot, your doctor will also want to monitor his weight. Some babies with GERD don't gain weight properly because they aren't keeping enough food down. Others lose their appetite because all that stomach acid pushing up into the esophagus can hurt the throat and, in severe cases, make it hard to swallow.
Also, if some of the stomach contents get into the nose or lungs, a baby with GERD might develop respiratory problems like pneumonia, a cough at night, or sinus or ear infections. The stomach acid can also damage tooth enamel.
What can I do to ease my baby's symptoms?
Try holding her in a more vertical position while feeding, and keep her upright for a bit right after feedings, too. (Don't put her down for tummy time or a nap – or even a diaper change – right after she eats, for example.)
Giving her less breast milk or formula at each feeding may help, too. You can make up for the smaller quantity with more frequent feedings. And make sure to burp her until you get a good burp after every feeding.
Ask the doctor if you should thicken your baby's breast milk or formula with a little rice cereal or use a formula that comes with "added rice." (The doctor will explain how to mix the cereal into milk or formula. You'll also need to use a bottle nipple with a wider hole or variable flow to allow the thickened fluid through.)
Keeping your child away from tobacco smoke can reduce reflux symptoms and is a good idea anyway.
While other parents may suggest letting your baby sleep in a car seat, experts don't recommend this because it seems to put more pressure on her stomach and may increase reflux symptoms.
In fact, experts generally don't recommend letting your baby sleep in a car seat, bouncy seat, or swing – even strapped in – because these products have not been studied for that purpose. They may have padding or inserts that pose a suffocation risk, and the baby could move enough to flip a car seat over when it's not installed in a car.
Also, never use a pillow or a sleep positioner to prop up your baby. They could cause your baby to suffocate.
Finally, while letting a baby sleep on her stomach may help with GERD symptoms, experts don't recommend it because it increases your baby's risk for SIDS.