Acid reflux is the movement of stomach contents upward to the esophagus and beyond. It is very common in healthy babies to see stomach contents flowing into and even out of the mouth. Some feeding and positioning modifications may help decrease the amount of reflux coming out a baby's mouth. However, while reflux may worsen temporarily -- typically around 4 months of age -- for almost all babies, things improve as they get closer to their first birthday, and more intensive treatment is not required.
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Frequency of Reflux in Infants
Healthy infants regularly reflux fluid from their stomach into their esophagus and mouth. Regurgitation or spitting up is reported to occur daily in half of all infants, according to a study in the May 2013 issue of "Pediatrics." The muscle separating the stomach and esophagus may not be as tight in young infants, allowing stomach contents to easily move up toward the mouth. So if your baby spits up his food, it is not abnormal, and it is not necessarily a problem that needs an intervention. Reflux nearly always decreases as infants age, and almost all will outgrow it by their first birthday.
Remedies and Interventions
Several steps can be taken to try to safely relieve problems due to reflux. Giving smaller amounts more frequently to achieve the same feeding volume in a day is one step. Considering the possibility of allergy is another. Some infants have an allergy to the proteins in cow's milk, and this causes reflux. Switching a formula-fed baby to a hydrolyzed or amino acid formula -- or eliminating cow's milk from the diet of a breastfeeding mother for a 2- to 3-week trial -- can confirm if cow's milk proteins are the problem. If you're bottle feeding, adding a thickener can decrease the amount of reflux that reaches the mouth -- the infants still experience reflux, but less reaches the mouth. Lastly, keeping an infant fully upright or on her stomach immediately after a feeding may decrease reflux symptoms as well, but putting babies to sleep on their backs is still advised. Babies should only be allowed to be on their stomachs if they are awake and closely watched.
For almost all infants, reflux improves with time and needs no intervention or treatment. The 2009 Pediatric Gastroesophageal Reflux Clinical Practice Guidelines indicate that high-quality studies have shown no improvement in reflux symptoms in infants on a medication called a proton pump inhibitor compared to infants who received a placebo. It may be hard to endure those months with your baby experiencing reflux multiple times per day, but sometimes no treatment is the best treatment.
Precautions and Seeking Help
While reflux is common in babies and almost always gets better with time, it can also be a sign of a more serious condition. Persistent vomiting in an infant may indicate a metabolic disease, an allergy or an intestinal tract abnormality. Talk with your child's healthcare provider early if your baby has recurrent reflux and particularly if you notice any other symptoms such as weight loss, fever or extreme fussiness. These are not a part of typical infant reflux and need to be investigated. Keep in mind, too, that even babies who reflux regularly still need to sleep on their backs. The risk of sudden infant death syndrome, or SIDS, outweighs any risk from acid reflux, and having the baby sleep on his back is the best way to reduce the likelihood of SIDS.
Medical advisor: Jonathan E. Aviv, M.D., FACS