Gastroesophageal reflux disease (GERD) occurs when the stomach contents pass into the esophagus (the tube that connects the mouth to the stomach), during or after a meal. Most infants with gastroesophageal reflux are happy and healthy even though they spit up or vomit. An infant with gastroesophageal reflux may experience:

• Spitting
• Vomiting
• Coughing
• Irritability
• Poor feeding
• Discomfort with feeding

Incidence

Gastroesophageal reflux occurs often in normal infants. More than half of all babies experience reflux in the first 5 months of life.

Only a small number of infants have problems due to gastroesophageal reflux. Most infants stop spitting up between the ages of 12 to 18 months.

Causes

There is a ring of muscle at the bottom of the esophagus, which opens and closes, allowing food to enter the stomach. This ring of muscle is called the lower esophageal sphincter (LES).

In infants, this sphincter is not as strong as that in older children and adults. The sphincter easily opens and the stomach contents often go up the esophagus and out the mouth (spitting up or vomiting).

Gastroesophageal reflux can also occur when babies cough, cry or strain as the pressure in their stomachs increases at these times.

Signs and Symptoms

In a small number of babies, gastroesophageal reflux may result in symptoms that are concerning. These include:

• Poor growth due to an inability to hold down enough food
• Irritability or feeding refusal due to pain
• Blood loss from acid burning the esophagus
• Breathing problems

Each of these problems can be caused by disorders other than gastroesophageal reflux. Your healthcare provider needs to determine if gastroesophageal reflux is causing your child's symptoms.

Diagnosis

An infant who spits up or vomits may have gastroesophageal reflux. The doctor or nurse will talk with you about your child's symptoms and perform a physical examination. If the infant is healthy, happy and growing well, no treatment or testing may be needed.

Sometimes, tests may be ordered to help the doctor or nurse determine whether your child's symptoms are related to gastroesophageal reflux. Often, treatment is started without the need for any tests.

Treatment

The treatment of reflux depends upon the infant's symptoms and age. Some babies may not need any treatment, as gastroesophageal reflux will resolve in many cases without treatment. Healthy, happy babies may need only to be kept upright after they are fed.

Overfeeding can aggravate reflux, and your healthcare provider may suggest a different feeding schedule. For example, smaller volume with more frequent feedings can help decrease the chances of reflux.

If a food allergy is suspected, your healthcare provider may ask you to change the baby's formula (or modify the mother's diet if the baby is breastfed). If a child is not growing well, feedings with higher calorie content or tube feedings may be recommended.

If your child is uncomfortable, or has difficulty sleeping, eating or growing, the doctor may suggest a medication. Different types of medicine can be used to treat reflux by decreasing the acid in the stomach.

Although these medications will help protect your child's esophagus from damage due to reflux, the medicines are unlikely to completely cure the spitting up.

Very rarely do infants have severe gastroesophageal reflux that prevents them from growing or that causes breathing problems. It is rare for infants to require surgery for gastroesophageal reflux. If surgery is necessary, your baby's doctor or nurse can discuss treatment options with you.