February 18, 2019

Spitting Up After Meals Isn’t Always Acid Reflux Disease

Regular regurgitation can be common for infants

Father holding crying baby after feeding

Your baby spitting up after every meal can be scary. But it’s not necessarily a sign of gastroesophageal reflux disease (GERD) or that your baby needs testing, medications or other therapies. This is according to 2018 guidelines reported jointly by the North American and European Societies for Pediatric Gastroenterology, Hepatology and Nutrition.


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Concerned parents may think their baby has GERD if he regurgitates regularly after eating. But this is normal in more than two-thirds of otherwise healthy infants.

This condition is known as uncomplicated gastroesophageal reflux, or GER, and research shows that most infants outgrow it by about 1 year old. When complications arise from GER, it’s then referred to as GERD.

Symptoms of GER

GER is marked by constant spitting up of meals and is sometimes accompanied by:

  • Coughing.
  • Hiccups.
  • Vomiting.
  • Irritability.

While these symptoms may be worrisome, parents shouldn’t jump to the conclusion it’s more than GER.


When GER becomes GERD

Pediatric gastroenterologist Jacob Kurowski, MD, says the complications indicating that your baby may have GERD, or something more serious, include these symptoms of GER, along with:

  • Poor weight gain.
  • Feeding refusal or difficulty feeding.
  • Coughing after feeds.
  • Pneumonia.
  • Excessive irritability (from acid coming up in the esophagus).
  • Sleep disturbances.
  • Vomit that is green (bilious).

If your baby has GER or GERD

The first-line therapy to relieve GER is to change positions while feeding, or give smaller but more frequent feeding. Nursing mothers should limit spicy and fatty foods, too.

If your baby does not improve, a breastfeeding mother may be recommended to eliminate cow’s milk in their diet. A formula-fed baby may have their formula changed to a broken-down protein (hydrolysate).

Medications are only to be used for treating GERD with no improvement after the previous changes, especially when the baby is vomiting or not gaining weight. Surgery is usually reserved for babies who are at risk for life-threatening complications.


Dr. Kurowski notes that the society’s guidelines are helpful in distinguishing infant reflux from more serious disorders, which may avoid unnecessary costs and treatments.

“If a baby has GER we can reassure families that they only need changes in feeding patterns, but likely not medications,” says Dr. Kurowski. “Babies with GERD would benefit from feeding changes as well as medical drug therapy.”

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