Gastroesophageal reflux disease (GERD)

What is GERD?

Gastroesophageal reflux disease (GERD) is a condition that causes food and acid to move backward from the stomach into the esophagus. The esophagus is the tube that connects the throat to the stomach. GERD occurs when the sphincter (or valve) in the esophagus doesn’t close properly.

My baby spits up often after feeding. Do they have GERD?

Most babies experience reflux or GER (without the “D” for disease). This can include some regurgitation (spitting up), burping, and/or vomiting after feeding. This does not cause them discomfort and most babies outgrow this by the time they can eat solid foods.

Since vomiting and regurgitation are common in babies, only a doctor can determine when a baby has GERD. The doctor may also need to rule out other conditions that have similar symptoms.

What are symptoms of GERD?

In babies, symptoms of GERD can include:

• spitting up of food or feedings with discomfort
• coughing
• irritability (back arching, neck twisting or pulling away) during feeding
• crying before or during feeding
• poor weight gain

Remember that crying, fussiness and/or back arching with or without regurgitation can also simply be part of your baby’s normal behaviour or stage of development.

How can I help my baby?

Most GERD symptoms should resolve on their own by the end of your baby’s first year. There is little evidence that medication improves symptoms, especially those related to crying and fussiness.

In general, you shouldn’t give medications to babies to treat crying, fussing, back arching or regurgitation in otherwise healthy babies. Often, the risks (including infections and weak bones) outweigh the benefits.

There are things you can do that may help your baby be more comfortable:

Thickened feeds:

Thickening breastmilk or formula over a trial period of 2 to 4 weeks may lessen the amount your baby vomits or regurgitates. You can use a commercial formula that has already been thickened; other thickeners can also be used. Thickening should only be done after discussing with your baby’s health care provider, to ensure that it is a good option for your baby and that it is done safely. ​Unless a commercial formula that has already been thickened is used, consulting a dietitian, occupational or speech therapist may also be necessary.

Thickening breastmilk or formula has no known effect on crying, fussing or other symptoms of discomfort.

Avoiding cow’s milk protein:

Eliminating cow’s milk protein over a 2 to 4-week trial period will not treat GERD, but it may relieve some symptoms. If breastfeeding, you can try eliminating cow’s milk protein in your diet. If formula-feeding, ask your health care provider to suggest a formula with protein that has been broken down to avoid allergies.

Can elevating my baby’s head improve GERD symptoms?

The Canadian Paediatric Society recommends that infants sleep on their backs and on a flat surface to prevent sudden infant death syndrome (SIDS). Positioning (laying baby on their side or elevating their head) should be avoided.

When should my baby see a doctor?

Call the doctor if your baby:

• isn’t gaining weight,
• doesn’t want to eat,
• cries a lot during feeds or when spitting up, or
• coughs a lot during or after feeds.