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What is acid reflux?
Q: Can you give me any information on acid reflux? My baby is 4 months old and has this problem and it doesn’t seem to be getting any better.
A: Patsy, acid reflux—or Gastro-Esophageal Reflux (GER)—is a common problem in the first year of life, especially in premature babies. It usually starts in the first few months with spitting up and irritability. Most infants outgrow reflux by 6 months of age, but sometimes it continues for up to 1-2 years.

Reflux is caused by immaturity of the muscles in the baby’s digestive tract, particularly the gastroesophageal sphincter, the muscle between the esophagus and the stomach. When your baby’s stomach is full with milk or air bubbles, or you bounce or lay down your baby after a feeding, the milk and stomach acid can “reflux” or come back up from the stomach.

Try to get to know your baby’s feeding patterns—how often she feeds, how fast, how much, in what position—and figure out what situations cause less reflux. Here are some other suggestions to help reduce reflux:
  • During the day, try to feed her before she gets too hungry, so she’s not gulping down food and air.
  • When you start giving your baby cereal and other solid foods, feed her the solid foods first, before her milk. This will help her fill up with food that she’s less likely to spit up.
  • When you feed your baby her breastmilk or formula, try giving her a little less than usual, but a little more frequently—this can help avoid over-filling her stomach at each feeding. Some doctors recommend thickening your baby’s milk with a little rice cereal, about one teaspoon of cereal per ounce of milk.
  • Try to keep the feedings calm and quiet. Take the time to burp your baby mid-feeding.
  • Feed your baby in a sitting or semi-sitting position, not lying down. Try to keep her in this position—either in your lap, her stroller, or an infant seat—for about 30 minutes after feedings.
Talk with your pediatrician about other recommendations for your baby’s reflux. The doctor will check your baby at each medical visit to make sure the reflux isn’t interfering with her growth or other aspects of her health. Be sure to let the doctor know if your baby vomits forcefully after feedings or there’s blood in the vomit, which could indicate a more serious problem. If your baby’s reflux is severe or persistent, your pediatrician may refer your baby to a specialist (pediatric gastroenterologist) for an evaluation, which may include special tests and x-rays of the stomach and esophagus. If necessary, the doctor may prescribe medications for your baby. When medications do not help, then surgery may be recommended; however, this is rarely necessary.

Karen Sokal-Gutierrez M.D., M.P.H. Pediatrician