When Does Reflux Peak in Babies?

Written by Jessica Holbrook, MSN, RN, CCRN

Published on May 12, 2023

• Over half of all babies experience acid reflux.
• Most babies outgrow reflux by 12 months of age.
• Some babies have severe reflux called GERD, which can cause distressing symptoms.
• See your child’s pediatrician if they experience weight loss, excessive crying, or trouble breathing. 

It’s completely normal for newborns and infants to spit up occasionally. In fact, babies can experience normal spitting up for up to eighteen months after they are born.

However, some parents notice that their infant develops troublesome symptoms like excessive vomiting, excessive crying, and trouble gaining weight. These symptoms may indicate gastroesophageal reflux disease. 

Severe acid reflux can make both babies and their parents miserable. Fortunately, most babies eventually grow out of newborn acid reflux. Parents of children with gastroesophageal reflux disease are often exhausted and discouraged by their babies’ constant crying and spit-up. 

If your child experiences infant reflux, you’re probably desperate to know: When does reflux peak in babies?

Understanding Reflux in Babies

Gastroesophageal reflux is extremely common in babies. In fact, experts at Seattle Children’s Hospital state that more than half of all babies experience reflux. Reflux can happen in both breastfed babies and bottle-fed babies. 

Reflux vs GERD

While almost all babies spit up occasionally, knowing whether your baby is experiencing normal reflux or gastroesophageal reflux disease (GERD) is important. The difference between the two does not necessarily depend on the amount of stomach contents that come back up but on the symptoms that accompany your baby’s spitting up. 

Babies with mild reflux are commonly referred to as “happy spitters.” These babies can have frequent wet burps, but they don’t seem uncomfortable when they lose their stomach contents. 

Babies with severe acid reflux or GERD may experience serious GERD complications like poor weight gain or significant respiratory difficulty. These babies often experience severe discomfort with even the tiniest spit-up. They may also have difficulty sleeping and may not tolerate laying flat.

What Causes Reflux in Babies?

When babies are born, their lower esophageal sphincter is not quite strong enough to keep all food and stomach acid in their tummy where it belongs. If their belly gets too full, undigested or digested formula and breast milk gets past the esophageal sphincter and comes back up through the mouth. This is the most common reason babies experience gastroesophageal reflux.

Mild Reflux

Babies who experience mild reflux may simply need adjustments to their feeding position, latch, or type of nipple on their bottle. Reasons your baby may spit up include: 

• Eating too quickly
• Swallowing air
• Laying flat right after feedings
• Poor Latch

Severe Reflux

While most babies’ reflux comes from an immature gastrointestinal system, some conditions increase the likelihood of more severe reflux. These include: 

• Cow milk protein allergy
• Food intolerances
• Pyloric stenosis
• Premature birth
• Cystic fibrosis

When Does Reflux Peak in Babies?

According to pediatric gastroenterology experts, it’s normal for babies to spit up 1–2 tablespoons of liquid at a time. Infants may even spit up after every feeding without suffering any serious complications. 

While spitting up is not necessarily dangerous for your baby, spit-up is exhausting for parents to deal with. Fortunately, the endless piles of laundry and days of getting spit up in your hair won’t last forever. 

Catherine Chao of the Pediatric Specialists of Virginia explains that reflux begins in babies around 2 weeks old and peaks at about 4–5 months. 

Does Reflux in Babies Subside at a Certain Age?

According to a 2015 study published in American Family Physician, most babies outgrow their acid reflux when they are around 12 months of age. This is true for babies with both mild and severe gastroesophageal reflux. It is uncommon for babies over the age of 18 months to continue spitting up.

Reflux that begins or gets worse after 6 months of age is abnormal, and should be reported to your family physician. 

Tips on How to Prevent and Manage Reflux in Babies

For most babies, the cure for reflux is time. Parents generally have to just wait until their child outgrows their reflux. However, there are a few things you can do to reduce mild reflux. 

1. Keep your baby upright after feedings.

One of the easiest ways to manage your child’s reflux is to keep them sitting upright after feedings. Laying your baby flat immediately after they finish a bottle or breastfeeding may aggravate reflux and make their symptoms worse. 

One of the easiest ways to keep your baby upright is to put them in a baby carrier against your chest. Babies with severe reflux may need to be held in an upright position for up to one hour after each feeding in order for gravity to help them keep their food where it belongs. 

2. Burp frequently during feedings.

Babies often swallow air while they are nursing or drinking from a bottle. If your baby seems to spit up frequently, try taking breaks during feedings to burp him.  

3. Check your diet.

If your baby’s frequent spitting up is accompanied by excessive crying, diarrhea, or gas, they may have a milk allergy or food intolerance. Breastfeeding mothers can try eliminating dairy from their diet, and parents who use formula may need to switch brands. 

While food allergies in children are rare, they can cause severe symptoms. 

4. Check your latch.

Breastfeeding mothers may want to speak with a lactation consultant to make sure their baby has a good latch. Babies with a poor latch or who latch and unlatch repeatedly are more likely to swallow air while breastfeeding, making gas and reflux worse. 

Many hospitals and OBGYN offices have lactation consultants available to help new moms improve their breastfeeding technique.  

5. Get a slow-flow bottle nipple.

A baby’s tummy is very small and can only hold a little bit of milk at a time. If a baby eats too quickly, their stomach can overfill, and their weak esophageal sphincter will let the milk come back up through their mouth. 

Purchasing a slow-flow nipple will keep your baby’s stomach from filling up too fast and may improve their reflux symptoms. 

6. Use thickened feeding.

For babies with severe reflux, the American Academy of Pediatrics recommends adding thickener like rice cereal to a baby’s bottle. This strategy should only be used for severe acid reflux, and with the guidance of a pediatrician. 

7. Ask about acid reflux medication.

In severe cases of reflux, your baby may need mediation. Pediatricians sometimes recommend treating reflux with medications like: 

• Cimetidine (Tagamet HB) 
• Famotidine (Pepcid AC)
• Omeprazole magnesium (Prilosec)

Most infants do not need medication for their reflux. 

Keeping Your Baby Safe

Since laying flat may make infant reflux worse, some parents choose to place their babies on an inclined surface while they sleep or lay them on their tummies at bedtime. These are dangerous habits that go against the American Academy of Pediatrics sleep safety tips. 

Even babies with severe acid reflux should be placed on a flat, firm sleep surface for sleep. Allowing babies to use inclined sleep positioners can cause serious breathing problems. 

When to See Your Child’s Pediatrician for Reflux

Most babies will outgrow their reflux. However, there are some reflux symptoms that parents should not ignore. These include: 

• Blood in their spit up or stool
• Crying for more than three hours per day
• Difficulty eating 
• Little or no weight gain
• Fewer than six wet diapers per day

FAQs

What is the best sleeping position for babies with reflux?

While friends and family may recommend letting your baby with reflux sleep at an incline, this is an unsafe practice. Babies should always sleep on a flat, firm surface—whether or not they have reflux. 

Do all babies outgrow reflux?

Healthy babies should outgrow their reflux by the time they are 12–18 months old. Children who continue to have reflux past this age may need to see a pediatric gastroenterologist. 

Can reflux cause long-term health problems for my baby?

Mild acid reflux will not cause long-term health problems for your baby. If your baby has trouble gaining weight due to their reflux, you should speak to your pediatrician about ways to help them get the nutrition that they need. 

References

1. Baird DC, Harker DJ, Karmes AS. Diagnosis and Treatment of Gastroesophageal Reflux in Infants and Children. American Family Physician. 2015 Oct 15;92(8):705-14. PMID: 26554410.
2. Chao, Catherine. The ultimate baby reflux survival guide. https://riseandshine.childrensnational.org/the-ultimate-baby-reflux-survival-guide/. Rise and Shine by Children’s National. Published September 01, 2020. Accessed May 11, 2023.
3. Mayo Clinic Staff. Infant Reflux. https://www.mayoclinic.org/diseases-conditions/infant-acid-reflux/symptoms-causes/syc-20351408. Mayo Clinic. Updated January 24, 2023. Accessed May 11, 2023.
4. Spitting Up – Reflux. https://www.seattlechildrens.org/conditions/a-z/spitting-up-reflux. Seattle Children’s Hospital. Updated December 30, 2022. Accessed May 11, 2023.
5. Tobias G. Wenzl, Sabine Schneider, Frank Scheele, Jiri Silny, Gerhard Heimann, Heino Skopnik; Effects of Thickened Feeding on Gastroesophageal Reflux in Infants: A Placebo-Controlled Crossover Study Using Intraluminal Impedance. Pediatrics. April 2003; 111 (4): e355–e359. 10.1542/peds.111.4.e355

The information WonderBaby provides is not intended to be, and does not constitute, medical or other health advice or diagnosis and should not be used as such. Always consult with a qualified medical professional about your specific circumstances.