Gastroesophageal reflux (GER) is a common occurrence in babies.

It is the return, spitting up or regurgitating stomach contents to the mouth, usually without effort and occasionally. It is most common after feeding.

Reflux occurs in about 1 in 5 healthy babies. It is considered a physiological and normal situation and should not be a cause of concern. Generally, it resolves without any treatment before the age of one year.

It is important to differentiate between physiological gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD), which occurs when the reflux of milk is more frequent and intense, causing inflammation of the esophagus (reflux esophagitis). In this case, the baby may have several symptoms (we will see this later), but most of all, it will be an irritable baby.

It is worth mentioning that exclusively breastfed babies have less gastroesophageal reflux because breast milk is digested faster and more easily than formula milk.

What are the symptoms of a baby with gastroesophageal reflux disease (GERD)?

As mentioned above, there may be several symptoms, including irritability (pain), vomiting or regurgitation (although not always present), refusal to feed because of pain, arching of the back when feeding, inadequate weight gain, respiratory symptoms such as coughing or wheezing noises in the chest.

How should breastfeeding be managed in a baby with reflux?

First of all, it is not recommended to stop breastfeeding.

Sometimes, commercial anti-reflux formula milk is used. These milks are thicker and, therefore, more difficult to bring up into the mouth. They tend to make less milk come out of the mouth, but there is a risk that the milk will remain “halfway,” thus irritating the esophagus, and you will not see the milk come out of the baby’s mouth.

As we have seen before, the fact that milk comes out of the baby’s mouth is not a problem as long as the baby is well, calm, and growing properly.

However, there can be important symptoms if this stomach content hurts the esophagus. Anti-reflux commercial formula milk is not always going to help in this regard. The most appropriate thing to do is to continue to nourish this child with breast milk.

What can be done if a baby has reflux?

One trick that can help when feeding babies with reflux is to breastfeed in a position that is as vertical as possible, for example, in an upright position.

Other anti-reflux measures are working with gravity: babywearing, raising the mattress, keeping the baby upright after each feed, and so on.

The motion of suctioning can also help. Sucking promotes the secretion of saliva, which neutralizes acid. Sucking also promotes digestion and bowel movement, which helps the stomach to empty more quickly, so there is less reflux. It can work if the baby does non-nutritional feeding at the breast (as the breast is never empty) or even suck from a pacifier.

Dr. Hortensia Vallverdú (pediatrician, lactation consultant, and mother of three)