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Reflux: What it is and how you can help.
Q: My pediatrician said my 3 ½-month-old baby has reflux. Can you tell me more about this? She will seem very hungry but will turn her head strongly to one side to push the bottle away.
A: Gastroesophageal reflux, or spitting up feedings, is common in young infants, especially in premature babies. It is caused by immaturity of the muscles in the baby’s digestive tract, particularly the gastroesophageal sphincter which is the muscle between the esophagus and the stomach. If the baby’s stomach is full with food or air bubbles, or the baby is bounced around or laid down immediately after a feeding, the food can “reflux” back up from the stomach. Usually, the baby spits up only a small amount of milk and it isn’t uncomfortable.

Each baby has her own pattern of feeding—how often she feeds, how fast, how much, etc… Try to get to know your baby’s patterns and figure out what situations are less likely to cause the reflux. Some tips to reduce your baby’s reflux are:
  • Try to feed your baby before she gets too hungry so she’s not gulping down the feeding and air; and try to keep feedings calm and quiet.
  • Follow your baby’s cues—when she turns her head away from the bottle, it means her stomach is full.
  • Take the time to burp your baby at least once 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 20 minutes after feedings.

  • Talk with your pediatrician about other special recommendations for your baby’s reflux. Some doctors recommend thickening the baby’s milk with a little rice cereal (1-3 tsp./oz.), having the baby sleep on her tummy, and raising the head of the crib on blocks. The pediatrician might also prescribe medication to treat the reflux.

    Most babies have only mild reflux that doesn’t interfere with their nutrition or growth, and they commonly outgrow the reflux by the time they’re eating solid food (4-6 months of age). Be sure to let the doctor know if your baby vomits forcefully after feedings, there’s blood in the vomit, or your baby is not gaining weight. If the reflux is severe and persistent, your pediatrician will probably refer your baby to a pediatric gastroenterologist for evaluation with special x-rays and other tests, and treatment which might involve medication and possibly surgery.
Karen Sokal-Gutierrez M.D., M.P.H. Pediatrician