Does Your Infant Have Gastroesophageal Reflux (GERD)?

by | Sep 20, 2021 | Physical Therapy

What is GERD?

The esophagus is the tube that goes from the mouth to the stomach. A muscle at the lower end of the esophagus should close after food is swallowed and has gone into the stomach. Gastroesophageal reflux occurs when this muscle is loose and does not close, or when it opens at the wrong time. When this happens, formula and stomach juices (acid) can come back up into the esophagus and may be vomited. This can irritate the esophagus and may cause pain. It can lead to breathing problems or failure to gain weight. 

Common Signs & Symptoms

0-1 Months

  • Difficulties latching & maintaining latch
  • Excessive body movement when feeding
  • Ear infections & respiratory issues
  • Coughs during or just after feeds
  • Frequently spits up milk after feeds (sometimes through the nose), especially with position changes


1-2 Months

  • Aggressively attacks nipple with vigorous sucking for 1-2 ounces then pulls away, arches, stiffens & cries
  • If baby is experiencing greater burning/pain, baby may be grazing (only eating about 1 ounce every 1 hour), & has learned to take in just enough food to decrease appetite, but not enough for full nutrients  


2-4 Months

  • Baby may prefer to be fed more upright & be held upright most of the time
  • Spitting up less but lots of wet burps  
  • Arching may continue, but you will see more of a bobbing movement
  • Coughing, sputtering & possible choking or aspiration
  • Baby will typically take no more than 1 – 1 1/2 ounce during feeds & will eat every 2 hrs
  • Tends to be fussy & irritable between feeds
  • Sometimes poor weight gain


4-6 Months

  • Struggling to learn to sit by themselves & pull themselves into sitting with help.  These activities increase compression of the stomach making the reflux worse.  
  • Increased spitting up & fussiness
  • Still having wet burps, coughing, & arching
  • Still eating more frequently & at lower volume for their age
  • May have slow weight gain

Reflux can continue past 6 months, however this blog is geared towards infants 0-6 months.  If your baby is experiencing any of these symptoms they may have GERD.

What Can You Do to Help Your Baby?

  • Hold your baby upright when feeding & do not prop the bottle.
  • Burp your baby after every 1-2 ounces in an upright position, but not with the baby in a sitting position. 
  • Do not overfeed your baby.  Feed baby volumes recommended by the pediatrician.  If reflux symptoms or vomiting occur, it may help to decrease the volume of each feed & to feed more frequently.
  • Place your baby on their back to sleep.
  • Avoid making dietary or formula changes without discussing it with the pediatrician.
  • Check bottle nipple & size.  If bottle feeding, keep the nipple filled with milk throughout feedings to avoid air gulping.  Try a variety of nipples, avoiding ones with larger holes that can cause milk to flow too fast.
  • Your pediatrician may prescribe medication to treat the reflux.

When to Call the Pediatrician

  • Baby seems to be in pain
  • Weight loss or failure to gain weight.  
  • Breathing issues, chronic coughing or wheezing
  • Fever – temperature higher than 100 degrees 
  • Vomiting half the feed or if vomiting worsens.  Streaks of blood in vomit.
  • No urination for 6+ hours and/or baby looks dehydrated 
  • Severe arching and preference to hold head turned one direction.  It is more common to see a left head turn preference in babies with reflux due to the angle of the stomach.  Babies can elongate their esophagus by turning their head to the left, sometimes relieving reflux symptoms.



 Chelan McDaniel, PTA