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Acid Reflux in Infants: Causes, Symptoms, and Treatment

   Most infants "spit up" milk as part of their daily activities. The action of spitting up milk is known as reflux or gastroesophageal reflux. Reflux is perfectly normal, common in infants, and is rarely serious.

Gastroesophageal reflux (GER) happens when the contents of the stomach wash back into the baby's food pipe. It is defined as reflux without trouble, and usually resolves itself.

Sometimes, a more severe and long-lasting form of gastroesophageal reflux called gastroesophageal reflux disease (GERD) can cause infant reflux.

Contents of this article:

Causes of reflux and GERD in infants
Symptoms
Diagnosis of reflux in infants
Treatments

Causes of reflux and GERD in infants
diagram of GERD
This diagram shows how acid reflux occurs with GERD.

There is a muscle at the lower end of the food pipe called the lower esophageal sphincter. This muscle relaxes to let food into the stomach and contracts to stop food and acid passing back up into the food pipe.

If the muscle does not entirely close, liquid flows back into the food pipe from the stomach. This sequence occurs in all people, but it happens more frequently in infants under the age of 1 year.

GER sometimes goes unnoticed, as the liquid remains in the lower food pipe, or the liquid is regurgitated and vomited.

Reflux, or regurgitation, is common in infants and peaks between 3-4 months of age. Some infants regurgitate at least once a day, while some regurgitate with most feeds.

Regurgitation rates decline as the muscle that controls the flow of food matures, usually by the time an infant is 18 months old.

Although more common in adults, GER can develop into gastroesophageal reflux disease (GERD). This condition may cause more troublesome symptoms and complications. Symptoms include slow weight gain, irritability, unexplained crying, and sleep disturbances. GERD requires treatment to avoid tissue damage to the lining of the food pipe.

Sometimes reflux in infants might be caused by a more serious condition, such as:

Food intolerance
Eosinophilic esophagitis, a buildup of a type of white blood cell that inflames or injures the tissue of the esophagus
Pyloric stenosis, an infant condition that blocks food from flowing into the small intestine
GERD

Risk factors

Most risk factors for infant GER are unavoidable and include:

Temporary relaxation of lower esophageal sphincter after feeding
Frequent large-volume feedings
Short food pipe
Laying down

The following conditions raise the risk of experiencing infant GERD:

Hiatal hernia
Neurodevelopmental disorders
Cystic fibrosis
Epilepsy
Congenital food pipe disorders
Asthma
Premature birth
Obesity
Parent history of reflux
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