Medications, Home Remedies, and More

By Cheryl Bird, RN, BSN 

 Medically reviewed by Jonathan B. Jassey, DO

Infant reflux is usually mild and does not need treatment other than simple lifestyle changes to prevent spitting up and discomfort. Reflux symptoms usually get better on their own by the time the child is 12 to 14 months old.12

However, babies with severe reflux (gastroesophageal reflux disease) may need medication or surgery.3

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s0ulsurfing - Jason Swain / Getty Images

This article discusses the treatment options for infant reflux, including what you can do at home to help your baby feel better.

Home Remedies

If you’re concerned about your baby’s symptoms, it’s important to talk to your pediatrician. If you’re waiting for an appointment, these at-home strategies may ease your baby’s reflux symptoms:2

  • Feed smaller amounts, more frequently: Babies are less likely to spit up if their tummy is not too full. Try giving your baby smaller, more frequent feedings.

  • Burp your baby: When air builds up in your baby’s stomach, the contents can get pushed up. Burp your baby often during and after feedings to prevent air from getting trapped in their belly.

  • Consider breastfeeding: Breastfed babies may be less likely to have reflux. Switching to breastfeeding may help with your baby's reflux symptoms.4

  • Keep your baby upright after feedings: Holding your baby upright for about 30 minutes after each feeding can reduce reflux symptoms. Putting your baby in a semi-upright position in a swing or bouncer after feedings may also help.

  • Ask your pediatrician about trying a different formula: If a food allergy is causing your baby’s reflux symptoms, your provider might recommend changing to a special infant formula with a different protein makeup (such as soy or a hypoallergenic formula).

  • Consider a dairy-free formula: If your baby is sensitive to cow's milk protein (called cow's milk protein intolerance or CMPI), they may have GI symptoms, including reflux. If your pediatrician thinks your baby's reflux could be triggered by dairy, they may recommend switching to only breastfeeding or trying a dairy-free formula to see if your baby's symptoms get better.5

  • Change your diet: If you’re breastfeeding, your baby can react to the foods you eat. If your baby is sensitive to cow’s milk, they may get reflux because you’re drinking milk. If your provider suggests you try cutting dairy out of your diet, be patient. It could take up to two weeks to see any improvement in your baby’s reflux symptoms.6

  • Try formula thickeners: Research has shown that thickening infant formula with powdered infant cereal may help reduce GERD symptoms in one to eight weeks. However, the American Academy of Pediatrics (AAP) says that infants should not be introduced to foods other than infant formula or breast milk before they are 6 months old—and that includes thickened formula.7 If your pediatrician gives you the OK, you can try adding 1 teaspoon of rice cereal to 2 ounces of formula. You can also get a pre-thickened formula.6

  • Avoid tobacco smoke: Exposure to cigarette smoke may increase your baby’s risk of reflux or make their symptoms worse if they have it.89

You may have heard that raising the head of the crib can reduce your baby’s GERD symptoms while they sleep. However, the AAP says that this practice “is ineffective in reducing” reflux. The AAP also advises against raising the head of your baby’s crib because doing so might be linked to sudden infant death syndrome (SIDS).10

Medicine for Reflux in Babies

At-home strategies are usually enough to improve mild cases of infant reflux. Most babies with reflux do not need medication and won’t benefit from taking it.6 However, babies with more severe cases of infant reflux may need medication. Signs that your baby may need medical treatment for reflux include:

  • Breathing problems from inhaling refluxed milk

  • Coughing, choking, or wheezing

  • Poor growth

  • Refusal to eat due to pain

  • Severe pain

Your infant’s pediatrician may prescribe medication if your baby has inflammation in the esophagus that damages the esophageal lining (esophagitis).6

The best acid reflux medication for babies depends on what symptoms a child has and what a pediatrician decides is the safest and most effective option.

Medications that can be prescribed for infant reflux include antacids, H2 blockers, and proton pump inhibitors. Your pediatrician may prescribe specific medications for you or tell you what over-the-counter (OTC) product you can safely give your baby. Keep in mind that you may need to try more than one medication or different doses or schedules to find what works for your baby.

Antacids

OTC antacids that treat infant reflux include Mylanta, Maalox, and Tums. Mylanta and Maalox can be given to infants who are older than 1 month. Tums are not recommended for babies under 1 year old.

Using antacids regularly may help babies with mild reflux.6 However, there are risks to giving babies antacids that you should discuss with your pediatrician. Stick to the dosing guidelines exactly if you’re giving your baby antacids for reflux.

Research has shown that infants who take high doses of antacids may have a higher risk of developing rickets, a condition where the bones become soft and weak.11 Maalox and Mylanta can also have a laxative effect at high doses and could give your baby diarrhea.

How They Are Used

Mylanta is available in a liquid form that you can mix with water or your baby’s formula. Your pediatrician may recommend a chewable antacid tablet that you can crush into a fine powder and mix into your baby’s formula.

If your pediatrician recommends that you give your infant an antacid, they will tell you exactly what dose to give them.

Mylanta can be given up to three times per day, but your pediatrician may suggest a different dose that’s based on your baby’s weight, age, and other factors.

In general, antacids should not be taken for more than two weeks. Always read the product labels closely before giving any medication to your baby. Call your pediatrician if your infant’s reflux symptoms do not get better within two weeks of starting the antacid formula.

Babies and Aspirin Don’t Mix

Make sure any medications you give your infant do not contain aspirin or bismuth subsalicylate (an ingredient in medications like Pepto-Bismol). The use of these drugs in children has been linked to a life-threatening condition called Reye's syndrome, which causes brain swelling and liver failure.12

H2 Blockers

Histamine (H2) blockers reduce how much acid is in the stomach by blocking a hormone called histamine. Providers may prescribe these medications for babies with reflux because they help heal the esophageal lining.

Prescription H2 blockers such as Pepcid (famotidine) are considered safe and are commonly used to treat reflux in babies and children. A liquid form of Pepcid can be used for babies, and kids can take chewable tablets. H2 blockers do come with a small risk of side effects, including abdominal pain, diarrhea, and constipation.

Some research suggests that long-term use of H2 blockers could negatively affect the protection offered by an infant's intestinal lining and increase the risk of bacterial infections.13

The best time of day to give a baby famotidine will depend on what your pediatrician has recommended. In general, famotidine is usually taken 15 minutes to 1 hour before eating.14

How They Are Used

OTC H2 blockers like Tagamet (cimetidine) and Pepcid can be found at your local pharmacy as liquids or tablets.

However, OTC H2 blockers are not FDA-approved for children younger than 12. Your infant will need a prescription if their pediatrician wants them to take H2 blockers for reflux.

H2 blockers work fast and can reduce your infant’s symptoms in as little as 30 minutes.15

Infection Risk

H2 blockers and PPIs reduce the amount of stomach acid in your infant’s stomach. Since stomach acid helps protect the body from infection, your infant’s risk of pneumonia and gastrointestinal infection can be higher while they’re taking these medications.16

Proton Pump Inhibitors

Proton pump inhibitors (PPIs) are more effective at reducing stomach acid than H2 blockers.3 The PPIs that are approved for infants over one month old are Nexium (esomeprazole) and Prilosec (omeprazole).

While PPIs are available OTC, the formulations are only for adults. Your provider will have to prescribe PPIs for your baby if they want you to try them for infant reflux.

PPIs have more long-term side effects than H2 blockers, like liver problems, polyps in the stomach, and lowered immunity against bacterial infection.17

How They Are Used

Providers usually prescribe PPIs for four to eight weeks. Your provider will consider your infant’s age, weight, and other factors when determining the right dosage to give them.2

Motility Agents

Motility agents like Reglan speed up digestion and empty the stomach faster, so they can help prevent reflux. However, studies have shown that these drugs are not consistently beneficial for reflux and have serious side effects. Therefore, they are generally not recommended for infants and children with GERD.18

Gas Relievers

OTC gas remedies for babies made with ingredients like simethicone may not specifically help with reflux, but they can relieve gas symptoms that could make the problem worse.

Ask your pediatrician about products that would be safe to give your baby for gas if they’re already taking medications to treat reflux.19

Surgery for Infant Reflux

In rare cases when a baby’s GERD symptoms are life-threatening, a surgical procedure called fundoplication might be needed. Your pediatrician may recommend the surgery if:20

  • GERD symptoms have lasted well beyond the first year of your baby’s life and are not getting better with treatment.

  • Your infant develops recurrent aspiration pneumonia because they breathe in regurgitated stomach contents.

  • Your baby has episodes of apnea during regurgitation where they are fully or partially unable to breathe for more than 20 seconds.

  • Your baby develops an irregularly slow heartbeat or rhythm (bradycardia).

  • Your baby has developed chronic lung disease (bronchopulmonary dysplasia) from damage to their airway.

  • Your infant is not growing properly because they are malnourished.

  • Your baby is at risk for choking because their esophagus is abnormally tight (esophageal stricture) due to inflammation.

During fundoplication surgery, the top of the stomach is wrapped around the esophagus to tighten the LES. The wrapping makes it harder for food to come out of the stomach and go up into the esophagus.

Fundoplication surgery can help children with severe reflux symptoms that do not respond to medication, but it’s still a major surgical procedure that has risks and potential complications. In addition, the procedure may not be effective for some children.20

 

When to Seek Help

If your baby has signs of reflux, like forceful vomiting after feeding, episodes of crying inconsolably for over two hours, refuses to eat or drink for long stretches, or has any changes in behavior, talk to your pediatrician.21

Getting a diagnosis and ruling out other causes for your baby’s symptoms are the first steps to finding a treatment that will help them feel better.

Infant reflux can be hard to manage and disheartening for caregivers. Many families try multiple remedies before finding one that works. Sometimes, a treatment that used to work will stop working after a few months, and the search starts all over again.22

The situation can test your patience, so it’s important to stay in touch with your pediatrician. It can also help to keep track of the treatments you’ve tried and how your baby reacts to them. Keep a log of any changes to your baby’s diet or routine, as this can affect infant reflux symptoms, too.

If your baby has GERD, consider working with a pediatric gastroenterologist who specializes in digestive health conditions in children.

Summary

Reflux symptoms in babies often get on their own by the time most infants are 14 months old. If your infant’s symptoms are mild, feeding them smaller meals and keeping them upright after they eat can help reduce reflux.

If your baby is diagnosed with GERD, your pediatrician may want them to take antacids, H2 blockers, or PPIs. Although effective, these medications can have side effects and risks that you and your pediatrician should discuss. If your baby’s GERD symptoms are severe and other treatments have not helped, surgical treatment of infant reflux might be considered.

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