Treatment of Gastroesophageal Reflux in Infants

The treatment of reflux depends on the infant's symptoms and age. Some babies may not need treatment, because GER often resolves by itself. Healthy, happy babies may only need their feedings thickened with cereal and to be kept upright after they are fed. Overfeeding can aggravate reflux, so your health care provider may suggest different ways of handling feedings. For example, smaller quantities with more frequent feeding can help decrease the chances of regurgitating. If a food allergy is suspected, you may be asked to change the baby's formula, or to modify your diet if you are breastfeeding, for 1 to 2 weeks. If a child is not growing well, feedings with higher calorie content or tube feeding may be recommended.

Speak with your child's health care provider if any of the following occur:
vomiting large amounts or persistent projectile (forceful) vomiting, particularly in infants under 2 months of age vomiting fluid that is green or yellow in color or looks like coffee grounds or blood difficulty breathing after vomiting or spitting up excessive irritability related to feeding, or refusing food, which seems to cause weight loss or poor weight gain difficult or painful swallowing

Other treatments include the following:

• When a child is uncomfortable, has difficulty sleeping or eating, or does not grow, the doctor or nurse may suggest a medication. Different types of medicine can be used to treat reflux by decreasing the acid secreted by the stomach. One class of medications, called H2-blockers, includes cimetidine (Tagamet), ranitidine (Zantac), famotidine (Pepcid), and nizatidine (Axid). Another type of medication is the proton-pump inhibitors, such as esomeprazole (Nexium), omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex), and pantoprazole (Protonix).*
  
  
• Very rarely infants have severe GER that prevents them from growing or causes breathing problems. In some of these infants, surgery may be the best option.

Your child's doctor or nurse will discuss GER with you and suggest treatment if needed. The potential complications of the medications will be explained. Most infants don't need medications and will outgrow reflux by 1 or 2 years of age.

* The authors of this fact sheet do not specifically endorse the use of drugs for children that have not been tested in children ("off label" use). Such a determination can only be made under the recommendation of the treating health care provider.

Specific Instructions for Infants With GER

• If the baby is bottle fed, add up to one tablespoon of rice cereal to 2 ounces of infant milk (including expressed breast milk). If the mixture is too thick for your infant to take easily, you can change the nipple size or cross cut the nipple.
  
  
• Burp your baby after 1 or 2 ounces of formula are taken. For breastfed infants, burp after feeding on each side.
  
  
• Do not overfeed. Talk to your child's doctor or nurse about the amounts of formula or breast milk that your baby is taking.
  
  
• When possible, hold your infant upright in your arms for 30 minutes after feeding.
  
  
• Infants with GER should usually sleep on their backs, as is suggested for all infants. Rarely, a physician may suggest other sleep positions.

source: http://digestive.niddk.nih.gov/ddiseases/pubs/gerdinfant/index.htm