Warning signs of reflux (GERD)

Warning signs of reflux (GERD)

Diagnosing and managing GERD in infants and children

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Dr. Stan Cohen, MD

Is a pediatric gastroenterologist at the Children’s Center for Digestive Health Care / GI Care for Kids, whose books on nutrition for parents led him to start Nutrition4Kids with his co-founders.

Spitting up (reflux) is common and completely normal in infants who are primarily bottle fed.  Usually, small amounts of a baby's stomach contents will come back up after eating. It can get worse at around 3 months of age, when babies start to get more active. Spitting up improves by around 5 months of age when babies can sit upright and begin eating solid foods.

If your child continues to spit up after 13 months of age, (s)he may have a more advanced condition called gastroesophageal reflux disease (GERD).  Here are more warning signs:

  • Poor weight gain
  • Excessive crying or irritability
  • Head usually tilted to one side
  • Feeding problems
  • Respiratory problems:  wheezing, apnea, noisy or difficult breathing, recurrent respiratory infections
  • Symptoms that continue beyond infancy  

Note: Sometimes these symptoms occur without the baby spitting up .

 Diagnosing Reflux 

Usually, spitting up makes reflux easy to diagnose. But it gets harder if he does not spit up, called silent reflux. Further tests may be in order if your baby has silent reflux or very intense symptoms.

If there's blood or bile in the spit up or he vomits forcefully, the baby may not  have reflux but some other condition. 

Managing GERD in infants and children: 

For mild cases of GERD, adjusting your baby's diet can help reduce symptoms.

  • Giving child smaller, more frequent feedings 
  • Adding infant cereal to breastmilk or formula to thicken it 
  • Switching to GERD safe formula (Enfamil AR and Similac Sensitive for Spit Up) 
  • Medications (acid blockers) in severe cases
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