The results of a study conducted by a group of pediatric gastroenterologists (doctors who specialize in conditions affecting the gastrointestinal tract) raise concerns about the overuse of anti-reflux medications in babies.

Researchers examined the records of 64 babies with persistent regurgitation (spitting and vomiting). Measurements of esophageal pH (a test used to diagnosis gastroesophageal reflux disease) were available for 44 of the 64 infants. Only 8 of the 44 babies had an esophageal pH suggestive of gastroesophageal reflux disease, yet 42 of 44 babies were already taking anti-reflux medication when seen by the pediatric gastroenterologist.

Researchers found that a parents’ perception of how much their baby spits up is greatly exaggerated. In most cases, parent education and reassurance and conservative treatment are all that is needed to manage reflux in the absence of other symptoms. However, it’s important for parents to distinguish between gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD).

GER occurs when stomach contents back up into the esophagus—the tube that connects the mouth to the stomach. A ring of muscle at the bottom of the esophagus opens and closes to let food enter the stomach. This muscle is called the lower esophageal sphincter (LES). In infants, when the LES opens, stomach contents often reflux (back up) into the esophagus and mouth.

GER is common in healthy infants. More than half of all babies experience reflux in the first 3 months of life, but most stop spitting up between the ages of 12 to 24 months. A small number of babies go on to develop severe symptoms typical of GERD. These include:

• poor growth due to an inability to hold down enough food
• irritability or refusing to feed due to pain
• blood loss from acid burning the esophagus
• breathing problems

The treatment for reflux depends on an infant’s symptoms and age. Most babies do not need treatment because GER often resolves by itself. Overfeeding can aggravate reflux, so small, frequent feedings are preferred. When an infant is uncomfortable, has difficulty sleeping, eating, or breathing, or does not grow, medication may be needed.

Suggestions for managing reflux include:

• Offer small, frequent feedings. Breastfeed well on a single breast before offering the second breast. A single breast can usually provide a full meal.

• Burp your baby during and after feeding.

• Do not overfeed. Talk with your baby’s doctor, nurse, or lactation consultant about the amount of breastmilk or formula your baby needs.

• Hold your baby upright in your arms for 30 minutes after feeding, or place your baby upright using a sling, wrap, or baby carrier.

• Like all babies, those with GER should sleep on their backs. In rare cases, your baby’s health care provider may suggest an alternative sleep position.