Does My Baby Have Heartburn?

What are your recommendations for infant reflux? My son is two months old and is gaining weight, but he exhibits a lot of reflux symptoms. Will he grow out of it?

– November 24, 2003

Reviewed on 3/10/2010

Gastroesophageal reflux disease (GERD) is very common among infants, but most outgrow it by the time they reach their first birthday, and it is rare for GERD to continue past the age of two. This condition occurs when acidic stomach contents move backward (reflux) into the esophagus, often because the muscle (called the lower esophageal sphincter) that connects the esophagus and stomach relaxes or is weak. Symptoms of GERD in babies include spitting up food or vomiting after eating; irritability or sudden crying after eating; a "wet burp" or "wet hiccup" sound; and poor weight gain or weight loss. Like adults with GERD, babies are probably experiencing the discomfort of heartburn.

I asked my colleague, Sandy Newmark, M.D., a California-based pediatrician on the faculty of the Arizona Center for Integrative Medicine, how best to treat GERD in babies. He noted that some degree of reflux is completely normal and nothing to worry about if your child is eating well and gaining weight as expected. Consult your child’s pediatrician if you see such symptoms as chronic cough, wheezing, poor sleep or irritability.

You may be able to make your baby more comfortable by holding him in an upright position while feeding him so that gravity can help keep the milk from coming back up. The La Leche League recommends using a sling or front carrier to position the baby at breast level and nurse while standing up, or else nursing from a reclining position with the baby slightly elevated. Some doctors recommend thickening formula with two to three teaspoons of rice cereal per ounce of formula. (When using a thickened formula, enlarge the bottle nipple to allow adequate flow.)

Another strategy is to give your baby less milk at each feeding but feed him more often. Be sure to consult your pediatrician if your baby’s reflux worsens, or if he doesn’t continue to gain weight normally. Medications are usually added only when GERD is abnormally serious. Otherwise, don’t worry. Chances are your baby will outgrow his reflux in a few months.

Andrew Weil, M.D.

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