The New Parents’ Guide to GERD: Answering Your Questions

Gastroesophageal regurgitation disease, or GERD, affects adults, but it’s also common in children. While babies spitting up is a fact of life, sometimes the spitting up can be a sign that something is wrong.

Babies and small children can be affected by acid reflux, also called gastroesophageal reflux or GER, just like adults. In some cases, the reflux can progress to what’s known as GERD. The distinction between GER and GERD is an important one.

“The first thing that parents need to understand is that there is a difference between gastroesophageal reflux and gastroesophageal reflux disease,” says Thomas Ciecierega, M.D., associate attending pediatrician at NewYork-Presbyterian Hospital, Weill Cornell Medical Center, associate professor of Clinical Pediatrics at Weill Cornell Medicine and director of the Pediatric Motility Program at Weill Cornell Medicine. “The difference is that in patients with GER, the patients just have reflux events, which tends to be a natural process. But in a very selective group of kids, the disease component can be present and that typically causes some troublesome symptoms that can affect their feeding, which can lead to weight loss.”

What Causes Reflux in Babies?

When reflux occurs, stomach acid and other contents back up into the esophagus. This process leads to heartburn and regurgitation.

“Reflux events usually occur in infants because of their immature GI system,” Dr. Ciecierega says. “We also have to understand that their dietary habits are quite different from us. They’re relying on liquids, like breast milk or formula, while solids tend to settle in the stomach a little bit better than liquids.”

Beyond differences in anatomy and diet, there are other reasons why reflux can commonly occur in young children.

“Infants are frequently in a lying position, because they’re asleep most of the time,” Dr. Ciecierega says. “So, it’s easier for liquid to move between the pharynx, the oral cavity and the stomach in a baby than in an adult who walks around with gravity bringing the stuff down. We have to also remember that the physical capacity of the esophagus and the stomach is very different than in adults.”

According to the American Academy of Pediatrics, GER symptoms often completely resolve by the time the baby is between 9 to 12 months old, as babies develop and begin to eat more solids.

When Is Reflex a Red Flag for GERD?

Spit-up, and even the flow of liquid out through the nose, is normal for all babies on occasion.

“It is not unusual and actually almost guaranteed that most of the infants will spit up early on,” Dr. Ciecierega says. “If spitting up doesn’t lead to weight loss or a lack of weight gain, excruciating pain, or aspiration pneumonia, the reflux will most likely get better with time.”

Some babies experience complications from GER, which are a sign of GERD. GER turns into GERD and becomes a cause for concern when it impacts a baby’s growth and development.

“If there’s any deviation in growth, that should be a concerning fact,” Dr. Ciecierega says. “If a baby is choking or gagging with the majority of feeds, that should also be a flag of concern that needs to be further evaluated. And if a baby is projectile vomiting in addition to spitting up, that needs to be evaluated.”

If your little one shows signs of GERD, your pediatrician will carefully examine your child and take a close look at feeding patterns and growth. Doing so can help determine whether your child simply has reflux or is experiencing GERD.

Children experiencing GERD are treated depending on the underlying cause of the condition.

Your medical provider may suggest dietary changes for the breastfeeding mother and tweaks to the way you’re feeding your child, including how frequently you’re feeding and the position in which you’re feeding. Medications may also be prescribed to alleviate and prevent the uncomfortable symptoms of GERD.

“In a child who otherwise is normal and just has reflux events, maybe is just a little uncomfortable, time is probably the best answer,” Dr. Ciecierega says. “Time will heal and improve symptoms in the long run.”

Concerned about the frequency of your baby’s regurgitation? Find a doctor at Weill Cornell Medicine.