Reflux in babies

Photo of a father with his baby (PantherMedia / Cathy Yeulet)

Parents are often seen with a burp cloth on their shoulder when carrying their baby: It absorbs milk that the baby spits up. There's usually no need to worry if your baby regularly spits up milk or food.

Babies gain a lot of weight in their first year, so they also need a lot of food. That can sometimes be quite tough on their digestive system, which is why babies often spit up milk in the first few months of life. It is quite normal for about a spoonful of milk to come back up.

Reflux is only rarely a sign that your baby is not well. If they are unwell, then they will generally have other symptoms too, such as not growing as quickly as they should be.

What causes reflux?

Food travels to the stomach through the esophagus (food pipe). There's a ring of muscle at the bottom of the esophagus, called the esophageal sphincter. This ring makes sure that food stays in the stomach once it gets there. But this ring of muscle often doesn’t work properly in babies, and their stomach is still quite small too.

Reflux isn’t the same as vomiting. When we vomit, the diaphragm and the muscles in the esophagus contract, causing food to be actively forced back out of the stomach. People usually feel nauseous too. In reflux, on the other hand, food simply rises back up the esophagus and a small amount flows into the mouth. The medical term for this is “regurgitation.”

Illustration: Esophagus with lower sphincter muscle, stomach and intestinesLower sphincter muscle of the esophagus

When is reflux normal?

A half to two thirds of all babies have reflux at least once a day until they are six months old. So there's no need to worry if your baby spits up often. It can be inconvenient sometimes, but as long as your baby doesn't have any other symptoms, it's perfectly normal. Babies don't spit up milk because they have been fed too much or because they don’t tolerate the milk.

Only 5 out of 100 babies spit up food once they are ten to twelve months old. The rest of them simply grow out of it without any treatment. The age at which reflux stops can vary. Some babies still spit up food regularly even once they are older than one year.

When do you need to see a doctor?

If your baby is well-fed and is growing healthily, it is unlikely that reflux is caused by an underlying medical problem. Babies who spit up but don't show any other symptoms don't have to be examined. However, you should see a doctor if your baby

  • spits up very frequently, isn't growing properly and isn’t gaining as much weight as should be expected at their age.
  • is in pain – then they will cry a lot or frequently arch their back.
  • coughs, wheezes or clears their throat frequently. This can be a sign that your baby’s esophagus is irritated by stomach acid.
  • doesn’t only spit up after being fed, but also when they haven’t eaten anything.
  • vomits: In other words, if the muscles in the stomach and intestines contract and larger amounts of food are spit up with greater force.
  • has a fever and diarrhea: If babies lose too much fluid, they can quickly become dehydrated, which can be very dangerous.

Reflux is only rarely a sign of something more serious, for example in premature babies and toddlers with illnesses that slow down their development. Frequent reflux can then be a sign that the intestines haven’t formed properly. If that is the case, your baby will probably vomit regularly and have stomach cramps that you can see or feel. It is then important to see a doctor very quickly.

Frequent reflux might also be a sign of gastro-esophageal reflux disease (GERD). In GERD, the food that comes back up can damage the food pipe or lead to respiratory illnesses if it gets into the lungs.