Infant Reflux

Has your little one ever spit up after a feeding, even an hour or two after eating? Maybe he burped and something came up that gave him a sour face? Or he started to move his tongue in and out and then you notice him swallow? All these babies were likely experiencing reflux.

Gastroesophageal Reflux (GER), simply referred to as reflux, occurs when contents from the stomach go back up in to the esophagus, the muscular tube that connects the throat to the stomach. The contents are then either pushed back down to the stomach or move up the throat and may become spit up or sometimes vomit. Dr. Kay Toomey, pediatric psychologist, reports that children and adults may reflux up to five times following a meal, but it typically does not bother them.

Most infants have reflux because the opening from the lower esophagus to the stomach does not mature until a baby is close to one year of age. It has been reported that as many as 60-70% of babies at 3-4 months of age experience vomiting related to reflux at least one time in a 24-hour period. Gastroesophageal Reflux tends to peak in infants around 4 months and spitting up tends to decrease around 12 months.

For many infants this does not cause problems. They do not experience fussiness when they spit up, continue to gain weight appropriately, and stay on track to meet developmental milestones. When complications arise from reflux it is referred to as Gastroesophageal Reflux Disease (GERD). If left unmanaged, GERD may lead to: failure to thrive, respiratory infections and/or possible asthma, scarring or strictures in the esophagus, ulcerations, inflammation of the esophagus, Sandifer syndrome (a combination of GERD and abnormal movements of the back and neck that may look like your little one is having a seizure), or feeding aversions to bottle, breast, and solid foods. As children get older they may be called “picky eaters” or limit what they eat due to discomfort or pain.

Infants with GERD may not spit up or vomit every time they experience reflux. Other indications that your infant is experiencing GERD include:

  • Difficulty latching or staying latched on a bottle or breast
  • Aggressively attacking the nipple for 1-2 ounces then pulling away, arching back and crying
  • Prevalent coughing, choking, wet burps, or aspiration (when fluid enters the lungs)
  • Wheezing, difficulty breathing, frequent upper respiratory infections
  • Coughing when laying on their back during naps or at night
  • Being irritable and fussy
  • Preferring to be fed in a more upright position
  • Arching their back or making a bobbing motion with their upper body
  • Not rolling over when developmentally appropriate
  • Failure to gain weight
  • Difficulty transitioning to solid foods

Signs and symptoms that older children are experiencing GERD include:

  • Have difficulty gaining weight
  • Are described as a “picky eater”
  • Limit the volume of liquids and/or solid food
  • Prefer to “graze” throughout the day
  • Vomit or report yucky tastes in their mouth
  • Complain of discomfort in their chest or stomach
  • Exhibit swallowing difficulties
  • Have breathing issues such as asthma, wheezing, hoarseness, chronic coughing, or frequent upper respiratory infections

There are a variety of strategies to help with reflux, but if signs/symptoms persist or worsen, such as the ones listed above, then your pediatrician may consider medical management or referral to a pediatric gastroenterologist. For additional information on reflux, MOSAIC has competent feeding therapists that can address your questions and assist your family if your infant or child is having difficulty with eating at any age.

References used for this article:

  1. Citroner, G. Medically reviewed by Gill, K. ((2017, November 20). Sandifer Syndrome. healthline. Retrieved from
  2. North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) Foundation for Children’s Digestive Health and Nutrition in collaboration with the American Academy of Pediatrics (2018). Parent’s Take Home Guide to GERD (Gastroesophageal Reflux Disease). Retrieved from
  3. Schwarz, S.M., & Hebra, A. (November 17, 2017). Pediatric Gastroesophageal Reflux: Practice Essentials, Background, Etiology, and Pathophysiology. Medscape. Retrieved from https://emedicine.medscape/com/article/930023-overview
  4. Toomey, K. A. (2002/2010). Consequences of Gastroesophageal Reflux and Breastfeeding. Colorado Breastfeeding Update.
  5. Toomey, K. A. (2002/2010). Developmental Timeline with Reflux.