Fort Worth, Texas,
12:42 PM

Let's Learn About ... Infant Reflux

When I asked my Facebook readers for any questions they may have about reflux, I received 179 questions within one hour! It’s definitely a hot topic at our Forest Park office and I talk about it with parents daily.

Here, I’m going to address infant reflux only – for babies under 12 months of age. Kids older than this can certainly experience reflux, but I’d like to keep this specific to this age group.

I’ve literally printed your questions out, and will use them as my guide!


Reflux is when the contents of the stomach (milk, food, stomach juices) goes up into the esophagus. Sometimes, it just stays in the esophagus and goes back down. Sometimes it comes all the way up and out the mouth (or nose).


The books say “more than half.”

I say: All of them. All babies. 100%. I watch all babies reflux in my office daily. It’s often subtle. A little dribble of milk out the side of the mouth, hiccups, gulping. Studies show that healthy infants experience reflux “30 or more times daily.” It tends to get started around week 3-4 of life, peaks around 2-4 months, and in most kids resolves by 12-18 months.


The valve where the esophagus meets the stomach is pretty loose in infants. So stomach contents can easily come up and down. Combine that with the fact that they are laying down a lot, drinking nothing but fluids, sometimes swallow excess air during nursing or bottle-taking, and have lower muscle tone in their bodies and it’s a perfect recipe for spit-up.


Well, spitting up is the most obvious sign. Some healthy normal kids spit up once a day. Some spit up numerous times after each meal (I had one of each – “normal” babies can be very different and there is a wide range of barfing!).

Sometimes it happens right after eating, and sometimes hours later. Sometimes it’s just a dribble out the side of the mouth, and sometimes you’re covered in puke. Sometimes it’s clear. Sometimes it’s chunky. Sometimes it’s straight up milk. Sometimes it’s acidic. Sometimes it’s not.

Other signs of reflux:

  • Hiccups
  • An acidic smell here and there
  • Coughing, especially when laying down
  • Congestion/snoring, especially after laying down
  • Arching the back
  • Fussing during feeds
  • Gagging out of nowhere
  • Gulping sounds


Well, that depends on the kiddo. For the vast majority of babies, you don’t have to do anything different. It’s a laundry problem more than a medical problem! Most babies are what we call “happy spitters” – lots of spitting up, lots of mess – but growing well, happy, and thriving. Thankfully, most kids are in this category and you may just need to try:

  • Frequent burping
  • Being held upright for 15-30 minutes after feeds.
  • A change of formula
  • A change of bottle type or nipple flow
  • Thickening of formula or breastmilk if other options don’t help (ask your pediatrician before you do this and we will walk you through it)


Most of the time, it’s less milk than you think. I always tell parents, “A stain on your shirt the size of a dinner plate is one ounce.” That’s pretty impressive, right? Talk to your pediatrician about whether s/he believes your child is gaining weight adequately at checkups to assure your baby is keeping enough in.


I worry if an infant is not gaining weight. I worry if the reflux causes consistent and constant refusal to feed, or disruption of feeds. I worry if an infant seems to be in pain MOST days (all babies have a bad day here and there). I also worry if:

  • The vomit looks dark green
  • The child’s vomiting is getting more consistently large and forceful
  • The baby has fever
  • The baby develops pneumonia (VERY rarely reflux can cause lung issues like wheezing and pneumonias)
  • There's blood in the stools, or very stringy mucus-y stools.
  • The child cries most of the day
  • The baby isn’t urinating at least every 6-8 hours

If any of these things are going on, please contact your pediatrician!

Sometimes, it takes more than just those simple methods above to help your child with reflux. It may take a medication or a change in a breastfeeding mom’s diet to improve symptoms. We also need to talk about safe sleep for a child with reflux.

All of this is addressed in Part 2!

Get to know Diane Arnaout, M.D.

Get to know Diane Arnaout, M.D., a Cook Children's pediatrician at Forest Park

"I didn’t realize how important the job of the pediatrician was until I had kids of my own. My education, experience in medicine, and cocky attitude made me feel like I knew it all before my first one came around. He proceeded to make me very aware of how little I actually knew.

Thankfully he survived, as did the next one, and they’ve helped me to grow and to help YOU, the parent, in so many ways. Sure I’m here to make sure your kids are healthy and happy at all ages. But I’m also here to make sure you’re educated, to make sure your family is thriving, and to make you feel confident in caring for your kids. From diaper rashes to sleep problems to school difficulties - I’m here to help.

I write a lot about common problems and ailments online – you can find me busy on Facebook and Instagram, and I write articles for the Cook Children’s Checkup Newsroom blog. A lot of stuff you’ll hear me say in the office will be typed out on there, too. And we’re in a day and age where the internet helps make connections – you can connect with me on there, or e-mail me anytime.

It takes a village to raise a child – and I’m so grateful to be a part of yours. And as Master Yoda teaches us – “Always pass on what you have learned.” I fully plan to!"

To schedule an appointment with Dr. Arnaout, click here.

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