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Gastroesophageal Reflux Disease (GERD) in Newborns

If the opening (sphincter) at the top of the stomach is too relaxed, stomach acid and other fluid can go up the tube (esophagus) that leads to the throat.

Reflux happens when gas or liquid from the stomach comes up the esophagus. It can cause babies to “spit up.” All babies have reflux from time to time. This is because in babies the muscle that opens and closes the top of the stomach is very relaxed. It opens easily, so gas and fluid tend to escape. Babies with severe reflux have gastroesophageal reflux disease (GERD). A baby with GERD may spit up too much and not get enough nourishment from food. The baby can also aspirate (breathe in) spit-up liquid. This can cause problems with the baby’s breathing.

When Does Reflux Need Treatment?

Reflux is treated if the baby:

  • Has apnea (breathing that stops for 15–20 seconds at a time).

  • Is growing poorly.

  • Develops pneumonia or breathing difficulties from breathing in spit-up liquid.

  • Is vomiting blood.

Propping a baby up after feeding helps keep fluid from traveling up from the stomach.

How Is Reflux Treated?

  • Feeding changes. This may include feeding smaller amounts more often, and burping more often during feedings. In other cases, allowing more time between feedings may help.

  • Propping the baby up after feeding. For 30 minutes after feeding, the baby is positioned with the head higher than the stomach. In most cases, the baby is laid prone (on the stomach). NOTE: It is okay to lay the baby prone in the NICU because the baby is being monitored. But this may not be the best position after the baby goes home. Unless told otherwise, once home you should put the baby to bed on his back or side to help prevent SIDS (sudden infant death syndrome).

  • Medications. This may include medications to decrease the acidity of the stomach. This keeps the stomach acids from damaging the esophagus. Other medications may be used to speed up digestion, so food passes out of the stomach quicker.

  • Surgery. In severe cases, a surgery called fundoplication may be performed. This creates an artificial valve at the top of the stomach. Part of the stomach is wrapped around the esophagus and secured with sutures. When the stomach is relaxed and empty, food can pass through. When the stomach is full, pressure closes the valve.

What Are the Long-Term Effects?

In most cases, reflux gets better over time and causes no long-term problems.

Online Medical Reviewer: Holloway, Beth, RN, M.Ed.
Online Medical Reviewer: MMI board-certified, academically-affiliated clinician
Last Review Date: 9/11/2014
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