Symptoms of Pediatric GERD and Infant Acid Reflux

Crying Newborn
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Gastroesophageal reflux disease (GERD) is a medical term doctors use to describe a condition in which food and stomach acid flow back up into the esophagus. A ring of muscles located the bottom of the esophagus - the lower esophageal sphincter (LES) - opens and closes to allow food to enter the stomach. The LES opens to release gas after meals.

More than gas may escape, however. The LES may also allow stomach contents to flow back into the esophagus and out the mouth.

Parents see the result as spitting up, though vomiting can occur. Although it's common for GERD to occur during or shortly after a feeding, it can also occur when a baby coughs, cries or strains.

GERD is common in infants and it has its own name: spitting up. Reflux occurs during the first 3 months of age in more than half of all infants. Many babies don't require treatment. Referred to as "happy spitters," their symptoms usually disappear between 12 and 18 months of age. However, for a small number of babies, symptoms of reflux are severe and medical evaluation and treatment is needed.

Symptoms of Infant Acid Reflux

Because your baby can't tell you what's wrong, it's important to keep an eye out for the things your baby is doing (or not doing). Common infant GERD symptoms include:

  • Frequent spitting up or vomiting
  • Irritability when feeding
  • Refusing food or eating only small amounts
  • Sudden or constant crying
  • Arching the back while feeding
  • "Wet" burps
  • Frequent hiccuping
  • Frequent coughing
  • Poor sleep habits with frequent waking
  • Bad breath

A small number of infants will experience the following less common symptoms:

  • Difficulty swallowing
  • A frequent sore throat
  • Weight loss or poor weight gain
  • Respiratory problems such as asthma, pneumonia, bronchitis, and wheezing
  • Frequent ear or sinus infections
  • Excessive drooling
  • Hoarse voice
  • Spells of not breathing

Diagnosing Infant Acid Reflux

If a baby is healthy and growing well, a doctor may make a reflux diagnosis based on a physical exam and parent's description of symptoms and feeding history alone. However, tests may be ordered if a doctor suspects a more serious condition such as GERD.

In these cases, diagnostic tests can include:

  • Lab tests. This can consist of various blood and urine tests to identify or rule out possible causes of recurring vomiting and poor weight gain.
  • Esophageal pH monitoring. This test will measure the acidity in the baby's esophagus.
  • Upper endoscopy. A tube with a camera lens and light (an endoscope) is inserted through the baby's mouth and into esophagus and stomach. The doctor may use this procedure to see if there is a narrowing (stricture) or inflammation (esophagitis) in the esophagus.

How Infant Acid Reflux Is Treated

Treatment of infant reflux depends on the severity of the problem. Your baby's doctor may decide no treatment is needed and that the reflux will disappear on its own as your baby grows older. For most babies, reflux resolves itself during the first year of life. If your baby is otherwise healthy, happy and growing, your doctor may recommend a few lifestyle changes for your baby in order to ease the reflux problem.

If the reflux is more serious, or if your baby has been diagnosed with GERD, your doctor may prescribe a prescription medication or over the counter remedy to help treat reflux. These remedies include:

  • Antacids. These neutralize stomach acid. They include Tums, Mylanta, and Maalox.
  • Acid suppressors. These suppress acid production in the stomach. They include Tagamet, Pepcid, Zantac, and Axid.
  • Acid blockers. These completely block acid production in the stomach. Prilosec and Prevacid have been approved for children over certain ages.

It is very important to discuss acid reflux treatment options with your baby's doctor before beginning any treatment method, especially before using any over the counter remedy.

See Also


"Gastroesophageal Reflux in Infants." NIH Publication No. 06–5419 August 2006. National Digestive Diseases Information Clearinghouse (NDDIC).

Heartburn, Hiatal Hernia, and Gastroesophageal Reflux Disease (GERD). NIH Publication No. 03–0882 June 2003. National Digestive Diseases Information Clearinghouse. 

Marsha Kay, M.D., Vasundhara Tolia, M.D. "COMMON GASTROINTESTINAL PROBLEMS IN PEDIATRIC PATIENTS." The American College of Gastroenterology. 

Brian Pace, MA, Richard M. Glass, MD. "Gastroesophageal Reflux in Children." JAMA, July 19, 2000---Vol 284, No. 3. The Journal of the American Medical Association.