Infant Acid Reflux: How to Tell When Your Baby Is in Pain

by Jennifer Mitchell Wilson B.S. Dietetics, Dietitian, Health Professional

Having a baby with acid reflux can be rough. Infants can't tell you exactly what is wrong, so parents are often left wondering whether their infant is fussy or in real pain -- which is why physicians developed the FLACC Scale (Face, Leg, Activity,Cry Consolability) and the Riley Infant Pain Scale to determine pain level in preverbal patients.

While those scales all use behaviors to evaluate pain, they can sometimes be difficult for a parent to understand. Here are some of the basic data each scale relies on, as well as stories from real reflux parents.** Sleeping disturbances**

"My [reflux] baby never slept." -- Suzanne T.

Poor sleeping is common in infants with acid reflux. Most frequently the added pain is due to an increase in stomach contents being splashed into the esophagus while the child is lying down. Both pain scales look at any sleep disturbance to evaluate pain levels. Any changes in your infant's sleep, especially in combination with other signs of pain, should be brought to your physician's attention right away.

Feeding issues

"My son acts like he wants to eat but fights every feeding. What he does get down he throws right back up."

-- Tammi A.

Feeding difficulties are very common issues in infants with acid reflux. Some infants may refuse to eat and have issues like gaining weight or Failure to Thrive (FTT), while others may "comfort feed," and then throw up everything they eat.

According to the Mayo Clinic, feeding issues and spitting up may be signs of a problem when:

  • Baby is not gaining weight

  • Spit up is forceful

  • Green or yellow fluid is in spit up

  • Blood is seen in the vomit or stool

  • Feedings are repeatedly refused

  • Baby has any additional signs of illness, like fever or breathing difficulty

  • The spitting up begins after the age of six months

Facial grimacing, flailing or twisting the body

As most of you know I have had two reflux babies. Both grimaced, twisted, flailed their arms and legs and screamed uncontrollably when they were in pain. Sometimes they would twist and move so much it was hard to keep a hold of them.

Abnormal bodily movements, according to the FLACC Scale, include:

  • Frequent or continued frown, grimace, clenched jaw or chin quivering

  • Kicking or drawing legs into the abdomen

  • Arching or jerking the body continually

If you see any of these signs it can help to videotape them for the pediatrician, or write down when they occur and their frequency. This can help your doctor to more quickly evaluate your child's pain -- especially as these episodes do not always occur while you and your child are in the physician's office.


Inconsolable crying

"My baby cries all night long. I rock, swaddle and breastfeed him but nothing stops the screaming or makes him feel better." -- Melissa H.

We all know that babies cry, but when does the crying become abnormal? Abnormal crying according to the pain scales includes crying that does not have many breaks or that is not quieted by comfort. Some ways to comfort a crying baby -- aside from the usual methods of feeding, changing diapers, or looking for signs of illness -- include:

  • Swaddling or carrying in a sling;

  • Rocking the baby;

  • Holding baby close with skin-to-skin contact;

  • Distracting with toys or music;

  • Using hushed tones and speaking gently.

"Sometimes all I could do was cry with him." -- Courtney B.

As Dr. Sears' Website* states, one of the most import things we have is parental instinct. If your intuition tells you to worry, you should seek medical attention -- even if it's a feeling like, "I just know something's wrong." That said, the tools and methods outlined in this article will help you to more readily determine if and when your reflux baby is in pain.

**NOTE: This article should in no way be seen as a substitute for your physician's advice. Please consult immediately with your physician concerning any issues your baby might be having.

Jennifer Mitchell Wilson
Meet Our Writer
Jennifer Mitchell Wilson

Jennifer Mitchell Wilson is a dietitian and mother of three girls. Two of her children have dealt with acid reflux disease, food allergies, migraines, and asthma. She has a Bachelor of Science in dietetics from Harding University and has done graduate work in public health and nutrition through Eastern Kentucky University. In addition to writing for HealthCentral, she does patient consults and serves on the Board of Directors for the Pediatric Adolescent Gastroesophageal Reflux Association.