Reflux is the backflow of stomach contents into the esophagus. Because the valve at the entrance of the stomach is not yet mature in babies, physiological reflux is very common: more than half of 4-month-old babies spit up at least once a day. A "spitting but smiling baby" who is gaining weight, happy, and feeding well does not need treatment; this picture usually resolves on its own by 12–18 months.

Signs That Suggest Reflux DISEASE

  • Failure to gain weight or weight loss
  • Crying during feeding, arching the back like a bow, refusing the breast
  • Bloody vomiting
  • Recurrent wheezing, prolonged cough, hoarseness
  • Treatment-resistant fussiness and sleep disturbance

If these signs are present, gastroesophageal reflux disease (GERD) and differential diagnoses (primarily cow's milk allergy) are evaluated.

What Can Be Done at Home?

  • Small and frequent feeding; keep the baby upright for 20–30 minutes after feeding
  • Effective burping
  • Not fastening the diaper too tightly
  • Sleep should always be on the back and on a flat mattress — raising the head of the bed and placing the baby on the side or stomach is not safe
  • For formula-fed babies, a thickened formula may be tried on the doctor's recommendation
  • Reflux tends to be milder in breastfed babies; breastfeeding should be continued

Is Medication Needed?

Acid-suppressing medications are used only in selected babies with proven reflux disease, under physician supervision; they are not started routinely for a "spitting baby."