Common Symptoms of GERD in Infants (Chronic Reflux)

Frequent spitting up and coughing can be signs of infant GERD

mother feeding crying baby
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Reflux occurs often in normal infants. More than half of all babies experience gastroesophageal reflux in the first three months of life. Reflux can become gastroesophageal reflux disease (GERD) when it irritates the esophagus and lasts for more than a year. Learn about the symptoms of chronic reflux and when to get medical attention.

Symptoms of GERD in Infants

Common infant GERD symptoms include the following:

  • Frequent spitting up or vomiting: Over half of all infants will spit up at some point during their first three months of life. Referred to as "happy spitters," they usually don't require treatment, and will usually outgrow this. For some infants, however, this spitting up, or reflux, is severe and requires treatment.
  • Irritability when feeding: This irritability includes whining, crying, screaming, and fussiness, which can last for varying amounts of time. This irritability can stem from the burning sensation and pain in the esophagus when formula and stomach acid is refluxed into the esophagus.
  • Refusing food or eating only small amounts: Infants may refuse to eat if pain occurs when they swallow. This pain can be caused by the irritation in the esophagus when formula and stomach contents are refluxed back up into the esophagus.
  • Arching the back while feeding: When babies are experiencing abdominal pain or discomfort, they will often arch their backs or draw up their legs.
  • "Wet" burps: When a baby has a "wet" burp, a small amount of liquid is regurgitated as he burps.
  • Frequent hiccups: Hiccups can be triggered by the stimulation of nerves found in the upper part of the stomach or lower part of the esophagus. The vagus nerve, which runs from the brain to the abdomen, can become irritated. This irritation can come from stomach contents entering the esophagus.
  • Frequent coughing: A frequent cough may occur if refluxed stomach acid is aspirated, irritating the airways, or when the stomach acid irritates the throat.
  • Poor sleep habits with frequent waking: When an infant is sleeping and his or her head isn't elevated, this allows stomach contents to press against the lower esophageal sphincter (LES), and can cause it to open inappropriately. When stomach contents are refluxed into the esophagus, it can cause coughing and a choking sensation, which in turn can make sleeping more difficult.

Less Common Symptoms of GERD in Infants

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

  • Difficulty swallowing: Pain caused by refluxed stomach acid into the esophagus can make it difficult for infants to swallow. An obstruction in the esophagus can also make it difficult to swallow, so any signs of swallowing difficulty need to be evaluated by a physician.
  • A frequent sore throat: When stomach contents back up into the throat, it can cause irritation and a sore throat.
  • Respiratory problems (such as asthma, pneumonia, bronchitis, wheezing): Several studies suggest a significant link between GERD and asthma. GERD can affect asthma when refluxed acid from the stomach is aspirated into the lungs and can make breathing difficult and cause the infant to wheeze and cough. This refluxed acid can cause other types of irritation in the lungs, leading to increased odds of pneumonia and bronchitis.​
  • Excessive drooling: Excessive drooling usually occurs from improper, inefficient, or infrequent swallowing. If irritation is present in an infant's throat because of refluxed stomach acid, the infant may find it difficult to swallow frequently maybe, and thus will drool more.
  • Hoarse voice: Irritation caused by refluxed stomach acid into the throat can lead to hoarseness.

When Should You Call the Doctor?

With reflux being common, at what point should you call your doctor? Here are signs that your baby needs to be seen by a doctor.

  • A large amount of vomiting
  • Recurring forceful vomiting, especially in an infant under 2 months old.
  • Vomit that is either green, yellow, has blood or looks like coffee grounds.
  • Any problem breathing after vomiting or spitting up.
  • If you baby won't feed and is losing weight or growing poorly.
  • If your baby cries for three or more hours in a day.
  • Signs of dehydration, including dry diapers.

A Word From Verywell

Reflux and spitting up are common for infants, and it is something that will happen less and less as their bodies mature. Discuss any frequent or unusual symptoms with your doctor. It could be that your infant has GERD and can begin treatment to relieve the symptoms.

Sources:

Acid Reflux (GER & GERD) in Infants. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-infants.

Kay M, Tolia V. Common Gastrointestinal Problems in Pediatric Patients. The American College of Gastroenterology. http://s3.gi.org/patients/gihealth/pdf/pediatric.pdf.

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