Gastroesophageal reflux (GER) occurs when stomach contents come back up into the esophagus (the tube that connects the mouth to the stomach) during or after a meal. A ring of muscle at the bottom of the esophagus opens and closes to allow food to enter the stomach. This ring of muscle is called the lower esophageal sphincter (LES). This sphincter opens to release gas (burping) after meals in normal infants, children, and adults. When the sphincter opens in infants, the stomach contents often go up the esophagus and out the mouth (spitting up or vomiting). GER can also occur when babies cough, cry, or strain. Most infants with GER are happy and healthy even though they spit up or vomit.
Symptoms GER occurs often in normal infants. More than half of all babies experience reflux in the first 3 months of life. An infant with GER may experience these symptoms:
- Poor feeding
- Blood in the stools
Only a small number of infants have severe symptoms due to GER. Most infants stop spitting up between the ages of 12 to 18 months.
In a small number of babies, GER may result in symptoms that are of concern. These include problems such as:
- 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
These problems can be caused by disorders other than GER. Your health care provider needs to determine if GER is causing your child's symptom(s).
Speak with your child's health care provider if any of the following occur:
- Vomiting large amounts or persistent projectile (forceful) vomiting, particularly in infants under 2 months of age.
- Vomiting fluid that is green or yellow in color or looks like coffee grounds or blood.
- Difficulty breathing after vomiting or spitting up.
- Excessive irritability related to feeding, or refusing food, which seems to cause weight loss or poor weight gain.
- Difficult or painful swallowing .
An infant who spits or vomits may have GER. The doctor or nurse will talk with you about your child's symptoms and will examine your child. If the infant is healthy, happy, and growing well, no tests or treatment may be needed. Tests may be ordered to help determine whether your child's symptoms are related to GER. Sometimes, treatment is started without tests.