Reflux in children and babies

Reflux (gastroesophageal reflux, GER) is a condition in which stomach contents flow back up into the esophagus. It occurs because the sphincter between the esophagus and the stomach is not yet fully developed in infants. About 50 percent of all babies under 3 months burp daily, and the vast majority outgrow it within 12-18 months.

What is reflux in babies and infants?

Reflux in babies is when stomach contents and acid flow back up into the esophagus after a meal. In most cases, it is a sign that the sphincter between the esophagus and the stomach is not yet mature enough to keep food down. The condition is very common and typically peaks around 4 months of age, after which it gradually decreases. A child with reflux who is thriving and gaining weight well is often called a "happy burper" — and rarely requires treatment beyond adjustments to daily routine.

There are two main types of reflux in babies. In classic reflux, the stomach contents come all the way up, and the child visibly spits up. In silent reflux, the stomach contents only flow up into the esophagus or throat and are swallowed back down without the child ever spitting up. Silent reflux is much more difficult to detect because there is no visible mess, but the stomach acid can still irritate the delicate lining of the esophagus, causing the child significant discomfort and pain.

A child with silent reflux may appear extremely restless, arch their back, or cry—especially during and after meals—without any other obvious cause. This is one of the most common reasons why parents seek help for a fussy or distressed infant, and the underlying cause can easily be overlooked if silent reflux is not kept in mind.

Symptoms of reflux in babies and infants

Symptoms vary depending on whether it is classic reflux or silent reflux. The most common signs are:

• Frequent or violent regurgitation and burping after meals
• Restlessness, crying, or obvious signs of pain during or after meals
• The child bends their back sharply backward during meals — the so-called bow-back position
• Repetitive swallowing movements, grunting or smacking sounds outside of mealtimes
• Sour smell from the mouth
• Restless sleep and frequent nighttime awakenings
• Coughing or wheezing during meals

With silent reflux, many of these signs will be present without visible regurgitation, which can make it more difficult to identify the cause of the child's restlessness.

Reflux in older children — is it the same?

Reflux is not only seen in infants. In older children, the symptoms begin to resemble those in adults: heartburn, sour taste in the mouth, difficulty swallowing, recurrent cough, hoarseness and stomach pain that worsens after meals. In a child of 2, 6 or 7 years, reflux may, for example, manifest as acid regurgitation or a persistent sore throat. Reflux in older children requires a medical evaluation to clarify the cause and the need for treatment.

What can be done about reflux in babies in everyday life?

For mild to moderate reflux, there are a number of practical measures that can significantly alleviate the child's discomfort. The most important are:

• Keep the child upright for at least 20-30 minutes after each meal
• Give shorter but more frequent meals to reduce pressure on the immature sphincter
• Take breaks during the meal to burp so that the air doesn't push the food up.
• Raise the headboard of the child's bed slightly so that the child does not lie completely flat.
• Avoid tight diapers and clothes that put pressure on the stomach, and avoid vigorous activity right after meals.

These measures do not cure reflux, but can significantly reduce the frequency and severity of episodes for many babies.

When does reflux go away in babies?

Reflux typically peaks around 4 months of age. Most babies gradually outgrow it as the sphincter matures and the child begins to sit more upright and eat solid foods. In the vast majority, reflux decreases significantly after 6 months of age and is completely gone by 12-18 months. In rare cases, reflux continues into toddlerhood and should then be investigated further.

When should you see a doctor for reflux?

Common reflux usually does not require medical treatment. However, there are certain signs that should prompt a medical evaluation:

• The child is not gaining enough weight or is losing weight
• The child consistently refuses to eat and seems afraid of meals
• The crying is persistent and characterized by obvious pain.
• The vomit is greenish or bloody.
• The child has breathing problems, persistent coughing or wheezing

These signs may indicate reflux disease (gastroesophageal reflux disease, GERD), which is a more serious form of reflux that requires medical evaluation and possibly treatment with medication.

Examination and treatment of reflux in children

The diagnosis is primarily based on a thorough interview about the child's symptoms, meal patterns, well-being and weight development. The clinical examination includes a general examination of the child. In most cases, no further examinations are needed, but in rare cases, if reflux disease is suspected, a more detailed examination may be needed.

Treatment depends on the severity. In the case of physiological reflux in a "happy burper", everyday adjustments as described above are usually sufficient. In the case of reflux disease with pain and poor well-being, medical treatment, dietary changes or - in very rare cases - surgical treatment may be considered after individual medical assessment.

Reflux in children at Charlottenlund Private Hospital

At Charlottenlund Private Hospital, your child can be examined by a pediatrician with experience in reflux and gastrointestinal problems in infants and children. The examination is based on a thorough conversation about the child's symptoms, meal patterns and well-being, and we emphasize that both the child and parents are safe and informed during the process.

 Based on the overall assessment, we clarify whether it is normal physiological reflux, silent reflux or reflux disease, and make a plan for the further course of action. If the child has sleep problems as a result of reflux, we can, if necessary, draw on our specialists in sleep and ear, nose and throat in the same course of action.