Acid reflux is common, especially for newborns and infants.
Many parents are surprised to know that reflux can affect older kids too though. Fortunately, reflux is temporary for most of these kids and can be easily treated.
It can be even easier to treat younger kids, most of whom don’t need any treatment if they are just messy and don’t have true acid reflux disease.
Happy Spitters and Reflux Symptoms
Children who spit up have acid reflux or more specifically gastroesophageal reflux (GER).
They may not have acid reflux disease though (GERD), with other associated signs and symptoms, such as:
- refusing to eat
- recurrent vomiting
- weight loss or poor weight gain (failure to thrive)
- irritability or trouble sleeping
- respiratory symptoms, such as a chronic cough, hoarse voice or cry, or hard to control asthma, etc.
- Sandifer syndrome – reflux plus head tilting and back arching
Without any of these symptoms, your baby who spits up, even if it is very frequent and it seems like they spit up a large amount each time, is likely what is classically called a “happy spitter.” If they are just messy, they don’t need any treatment and you can wait until they outgrow their reflux.
Remember – “Spit Happens.”
Older children with acid reflux might complain of heartburn, chest pain, or say that they have a sour taste in their mouth (sour burps).
Lifestyle Changes for Reflux
Once you recognize that your child has GERD and needs to be treated, you might start with these lifestyle changes:
- avoiding milk and dairy products for two to four weeks if you are breastfeeding an infant with GERD
- changing baby formula to an extensively hydrolyzed protein (Nutramigen, Gerber Extensive HA, Alimentum) or amino acid–based infant formula if your formula fed baby has GERD
- thickening your baby’s formula (typically about one tablespoon of rice cereal per every one to two ounces of formula) vs switching to a baby formula for reflux (Enfamil AR or Similac Sensitive R.S.)
- making sure you aren’t overfeeding your baby, including that you don’t re-feed your baby right after they spit up
- avoiding seated and supine (on his back) positions after feedings, although you shouldn’t put your baby down prone (on his stomach) if he is going to fall asleep (risk factor for SIDS)
- helping older children with acid reflux lose weight if they are overweight and making sure they don’t smoke or drink alcohol
- encouraging older children to avoid acid reflux triggers, especially caffeine, chocolate, foods with acid, and spicy foods
When can you expect your infant’s reflux to go away? In most babies, reflux symptoms peak at about 4 months and go away by the time they are 12 to 18 months old. In older children, reflux symptoms generally go away after a few months of appropriate treatment.
Acid Reflux Medicines
If lifestyle changes aren’t working, your child with reflux likely needs medicine to treat his reflux.
These acid reflux medications include:
- antacids – may be okay in older children with very rare symptoms, but not for routine use
- histamine-2 receptor antagonists (H2RAs) – such as Zantac (ranitidine) – works quickly, but may stop working over time (tachyphylaxis)
- proton pump inhibitors (PPIs) – such as Prevacid (over-the-counter for adults) and Nexium (Nexium packets are FDA approved for infants) – considered more potent and superior to H2RAs but may take up to four days to start working
- prokinetic agents – rarely used because of side-effects
In general, if your child’s symptoms improve or go away within two weeks of taking an acid reflux medication, then you should likely continue it for at least two to three months.
Treating Hard to Control Reflux
What do you do when lifestyle changes and reflux medicines don’t work or symptoms return after you stop your child’s reflux medicine?
First, make sure you are giving the right medicine, the right dosage of medicine, and are giving it at the right time, keeping in mind that PPIs should be giving 30 minutes before a meal.
Next, consider if there are any other lifestyle changes that you can try. For example, you might encourage your older child with persistent reflux to eat smaller meals more frequently, avoid a bedtime snack, and you may even elevate the head of his bed by about 30 degrees.
Lastly, you might make sure that your child really does have reflux.
Just because your baby is fussy and wakes up a lot at night, it doesn’t automatically mean that he has reflux. It could instead be colic, or be related to a food intolerance or allergy, with breastfeeding mothers needing to go on a more restrictive diet or infants drinking a hydrolyzed formula might need to switch to an elemental formula (Elecare, Neocate, or PurAmino).
Older kids with difficulty swallowing (dysphagia), which is often blamed on acid reflux, might have post-nasal drip caused by allergies or a sinus infection, etc.
And even if truly spitting up, instead of GERD, a child might have any number of other conditions instead of GERD, from an intestinal obstruction to a metabolic disorder.
It is usually at this point, when classic acid reflux treatments aren’t working, that a referral to a pediatric gastroenterologist would be a good idea.
What To Know About Acid Reflux
Acid reflux in kids is usually temporary and can often be controlled with lifestyle changes and medications, but unfortunately, acid reflux symptoms are not always caused by reflux, leading to some treatment failures.
For More Information on Acid Reflux
- GI Kids – Reflux and GERD in Infants
- GI Kids – Symptoms and Treatment of GERD in Teens
- GI Kids – Coping with Your Baby’s Reflux or GERD
- GI Kids – Parents Take Home Guide to GERD
- NIDDK – Acid Reflux (GER & GERD) in Infants
- NIDDK – Acid Reflux (GER & GERD) in Children and Teens
- Eat Right – What You Need to Know About GERD
- SBM – Separating Fact from Fiction in Pediatric Medicine: Infant Gastroesophageal Reflux
- Healthy Children – GERD/Reflux
- Living With Reflux
- Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN)
Last Updated on December 3, 2016 by Vincent Iannelli, MD