Your doctor will start with a physical exam and questions about your baby's symptoms. If your baby is healthy, growing as expected and seems content, then further testing usually isn't needed.
If further testing is needed, your doctor might recommend:
- Ultrasound. This imaging test can detect pyloric stenosis.
- Lab tests. Blood and urine tests can help identify or rule out possible causes of recurring vomiting and poor weight gain.
- Esophageal pH monitoring. To measure the acidity in your baby's esophagus, the doctor will insert a thin tube through the baby's nose or mouth and into the esophagus. The tube is attached to a device that monitors acidity. Your baby might need to stay in the hospital while being monitored.
- X-rays. These images can detect abnormalities in the digestive tract, such as an obstruction. Your baby may be given a contrast liquid (barium) from a bottle before the test.
- Upper endoscopy. A special tube equipped with a camera lens and light (endoscope) is passed through your baby's mouth and into the esophagus, stomach and first part of the small intestine. Tissue samples may be taken for analysis. For infants and children, endoscopy is usually done under general anesthesia.
Infant reflux usually clears up by itself. In the meantime, your doctor might recommend:
- Giving your baby smaller, more-frequent feedings.
- Interrupting feedings to burp your baby.
- Holding your baby upright for 20 to 30 minutes after feedings.
- Eliminating dairy products, beef or eggs from your diet if you're breast-feeding, to test if your baby has an allergy.
- Switching the type of formula you feed your baby.
- Using a different size of nipple on baby bottles. A nipple that is too large or too small can cause your baby to swallow air.
- Thickening formula or expressed breast milk slightly and in gradual increments with rice cereal. Although recognized as a reasonable strategy, thickening adds potentially unnecessary calories to your baby's diet.
Reflux medications aren't recommended for children with uncomplicated reflux. These medications can prevent absorption of calcium and iron, and increase the risk of certain intestinal and respiratory infections.
However, a short-term trial of an acid-blocking medication — such as cimetidine (Tagamet HB) or famotidine (Pepcid AC) for infants ages 1 month to 1 year or omeprazole magnesium (Prilosec) for children ages 1 year or older — might be recommended if your baby:
- Has poor weight gain and more-conservative treatments haven't worked
- Refuses to feed
- Has evidence of an inflamed esophagus
- Has chronic asthma and reflux
Rarely, the lower esophageal sphincter is surgically tightened to prevent acid from flowing back into the esophagus. This procedure (fundoplication) is usually done only when reflux is severe enough to prevent growth or to interfere with your baby's breathing.
Lifestyle and home remedies
To minimize reflux:
- Feed your baby in an upright position. Also hold your baby in a sitting position for 30 minutes after feeding, if possible. Gravity can help stomach contents stay where they belong. Be careful not to jostle or jiggle your baby while the food is settling.
- Try smaller, more-frequent feedings. Feed your baby slightly less than usual if you're bottle-feeding, or cut back a little on the amount of nursing time.
- Take time to burp your baby. Frequent burps during and after feeding can keep air from building up in your baby's stomach.
- Put baby to sleep on his or her back. Most babies should be placed on their backs to sleep, even if they have reflux.
Remember, infant reflux is usually little cause for concern. Just keep plenty of burp cloths handy as you ride it out.
Preparing for your appointment
If reflux continues after your child's first birthday, or if your child is having symptoms such as lack of weight gain and breathing problems, you might be referred to a doctor who specializes in children's digestive diseases (pediatric gastroenterologist).
What you can do
- Write down your baby's symptoms, including how frequently your baby spits up and the amount of liquid that is spit up.
- Write down key medical information, including how often you feed your baby, how long the feedings last and the brand of any formula that you are using.
- Write down questions to ask your doctor.
Questions to ask your doctor
- What's the most likely cause of my baby's symptoms?
- Does my baby need any tests?
- What treatments are available?
- Should I make any changes in how or what I feed my baby?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask other questions during your appointment.
What to expect from your doctor
Your doctor is likely to ask you a number of questions, including:
- When did your baby's symptoms start?
- Does your baby spit up with every feeding or only occasionally?
- Is your baby content between feedings?
- Have you recently switched from breast-feeding to bottle-feeding? Or have you switched infant formulas?
- How often do you feed your baby, and how much does your baby eat at each feeding?
- If you have different caregivers, does everyone feed the baby the same way each time?
- Does anything seem to improve or worsen your baby's symptoms?