Expert Health Articles

Reflux in Infants

Ailing Chen, MD

Caughman Health Center

It is very common for a baby to have reflux after feeding, also known as spitting up. At least 90 percent of babies have some reflux symptoms by four months of age and more than 50 percent of babies spit up regularly in the first months of life. Good news, spitting up gets much better after six months and usually stops by 12 to 18 months. A majority of these babies grow well without medication.

What causes reflux for babies?

In an infant, the ring muscle between the esophagus and stomach, called esophageal sphincter, is not well developed or tight enough, especially for premature babies. This muscle is supposed to be closed after babies swallow, to prevent stomach content from flowing backwards. Meanwhile, babies spend most of their time lying flat after feeding. At the same time, babies eat completely liquid diets for the first four months of life, either breastmilk or formula.

If the baby is growing properly, reflux is not a problem and the baby usually doesn’t need any medication.  

What to do to decrease spitting up at home:

1. Breastfeeding if possible. Most babies tolerate breast milk much better than formula.

2. Decrease the size of each feeding, feed more frequently and avoid overfeeding the baby. For babies under four months old, each feeding should be less than four ounces.

3. Don’t immediately feed the baby again if the baby spits up. Wait at least one to two hours.

4. Burp your baby more frequently throughout feeding

5. Keep your baby in an upright position for about 15 to 20 minutes after feeding.

6. Avoid exposure to tobacco smoking.

7. Avoid changing the diaper or changing clothes right after a full feeding.

However, please call and see your baby’s doctor if your baby shows the following signs:

  • Baby is not gaining weight
  • Baby constantly spits up forcefully, especially projectile vomiting
  • Baby spits up yellow fluid/blood or has blood in their stool
  • Baby has a bad cough, wheezing or stops breathing
  • Baby is unusually irritable after feeding

Some of these signs can indicate other severe diseases, which require further evaluation and treatment.