How To Treat Infant Acid Reflux: Signs, Remedies, And GERD Guide

By: Janett King

How-To-Treat-Infant-Acid-Reflux-Signs-Remedies-And-GERD-Guide

When is spit-up more than just spit up?

It starts innocently enough. A soft gurgle, a small arch of the back, maybe a tiny splash on your shirt. But then it happens again. And again. The spit-up becomes more frequent. Your baby fusses after feeding, squirms while nursing, or cries in the middle of the night for reasons you can’t name. If you’ve ever held your baby in those moments, wondering if this is normal or something more serious, you’re not alone.

Infant acid reflux is common, but that doesn’t make it easy. For many families, it comes with disrupted sleep, constant laundry, and more than a few tears from the baby and parents. While most cases are mild and improve over time, some babies develop gastroesophageal reflux disease, or GERD. This guide explains why reflux occurs, how to distinguish between typical spit-up and GERD in babies, and what you can do to manage symptoms with confidence and care backed by science.

What causes acid reflux in babies?

Acid reflux in infants happens when the contents of the stomach flow backward into the esophagus. While it may sound alarming, this process is surprisingly normal in babies, especially in the first few months of life.

At the center of this issue is a small muscle called the lower esophageal sphincter (LES). In adults, this muscle acts like a one-way valve, opening to let food in and closing to keep stomach contents where they belong. In babies, the LES is still developing, which means it can open at the wrong time or fail to close properly. This immaturity is the most common reason for reflux.

Several other factors make babies more prone to spit-up:

Lying flat most of the day, which allows gravity to work against digestion
Liquid diets (breast milk or formula), which move more easily through the digestive tract
Small stomach capacity, which fills and overflows quickly
Frequent feeding which increases the chance of reflux events

In most cases, this type of reflux, called physiologic reflux, is not harmful. But when reflux becomes persistent, painful, or affects growth and sleep, it may indicate a more complex issue.

Is it normal for babies to spit up after every feeding?

Yes. And no. For many infants, especially those in the first three to six months, spitting up after feedings is a common occurrence. It can happen once or multiple times a day. Studies show that up to 70 percent of healthy infants experience reflux in their first few months.

Spit-up is normal when:

Your baby is still gaining weight appropriately
They don’t seem uncomfortable or distressed
Feedings are otherwise going well

But frequent spit-up becomes a concern if:

It’s projectile (forceful)
t contains blood or bile (green or yellow fluid)
It leads to coughing, choking, or breathing issues
It interferes with weight gain or causes dehydration

One way to evaluate whether spit-up is harmless or a cause for concern is to monitor your baby’s weight gain, the number of wet diapers each day, and their overall mood between feedings. If your baby is growing well, staying hydrated, and generally content, occasional spit-up is likely a normal part of their development. But if feeding becomes difficult or your baby shows signs of pain or distress, it may be time to take a closer look.

How can I tell if my baby has reflux or GERD?

Spit-up is a familiar part of early parenthood. Most babies do it. Some may spit up several times a day and still be perfectly happy, growing well, and thriving. In these cases, reflux is typically a normal part of development and not something to be concerned about.

However, when spit-up becomes more than just a laundry issue and is accompanied by signs of pain, feeding struggles, or disrupted sleep, it may be a sign of something more complex. Gastroesophageal reflux disease is a chronic condition in which stomach contents frequently flow back into the esophagus, causing irritation, discomfort, or complications. In infants, GERD occurs when this backflow is more severe, persistent, or causes problems with feeding, growth, sleep, or breathing.

Unlike normal reflux, which is common in babies due to an immature digestive system, GERD involves symptoms that interfere with a baby’s overall well-being. It may cause pain during or after feeding, refusal to eat, poor weight gain, or respiratory issues, such as coughing and wheezing.

GERD is typically diagnosed by a pediatrician based on a combination of symptoms, feeding history, and growth patterns. In some cases, further evaluation or treatment may be recommended to help reduce symptoms and support healthy development.

Understanding the differences between typical reflux and GERD can help you know when to seek extra support.

Signs of normal reflux, also called physiologic reflux:

Frequent but effortless spitting up, especially after feeding
Small amounts of milk come up with burps
No signs of discomfort or pain during or after feeds
Steady weight gain and normal growth
Baby seems generally happy and relaxed between feeds

Symptoms that may indicate GERD in your baby:

Crying, irritability, or arching of the back during or after feeding
Refusing to eat or pulling away from the breast or bottle
Difficulty settling or sleeping due to discomfort
Poor weight gain or noticeable weight loss
Frequent coughing, choking, or gagging while feeding
Recurrent wheezing, congestion, or respiratory symptoms

The key difference is not how often your baby spits up, but how they respond to it. GERD often causes pain or distress and may interfere with your baby’s ability to feed, grow, or rest comfortably.

If you notice signs of discomfort or increasing fussiness during feedings, or if your baby seems inconsolable and you suspect reflux may be part of the issue, it’s a good idea to check in with your pediatrician. Together, you can assess your baby’s symptoms, explore potential causes, and determine the most suitable course of action.

How can I treat acid reflux in my infant without medication?

When reflux is mild and your baby is otherwise healthy, non-medicated, natural interventions are often the first line of care. These gentle changes focus on improving feeding techniques, positioning, and overall digestive comfort. While not a quick fix, they can make a noticeable difference over time. Many parents report reduced symptoms and improved quality of life for their baby without the need for medication.

Offer smaller, more frequent feeds

Your baby’s stomach is roughly the size of a walnut in the early weeks and gradually expands with growth. Offering large volumes of milk in one sitting can easily overwhelm this small space, leading to backflow into the esophagus. By feeding more often in smaller amounts, you reduce the pressure inside the stomach and make digestion more manageable for your baby’s developing digestive system.

Why it helps: Smaller feeds mean less stretching of the stomach wall and a lower risk of contents pushing past the lower esophageal sphincter, which is often still maturing in infants.

Hold your baby upright after feedings

After your baby finishes eating, staying upright helps gravity do its job. Holding your baby in an upright position for 20 to 30 minutes after each feed allows stomach contents to settle and reduces the likelihood of them flowing backward into the esophagus.

Why it helps: Infants spend much of their time lying flat, which makes it easier for reflux to occur. Upright positioning after feeds provides natural support for digestion, allowing the LES time to close securely.

Try paced bottle feeding

Paced feeding is a bottle-feeding technique designed to mirror the slower, more controlled rhythm of breastfeeding. Instead of letting milk flow freely into your baby’s mouth, you hold the bottle more horizontally and allow your baby to suck and pause at their own pace. You can also gently tip the bottle down during short breaks to give your baby time to rest, swallow, and reset before continuing.

This method helps babies learn how to self-regulate their intake, preventing them from taking in too much milk or air too quickly.

Why it helps: When babies gulp milk rapidly, especially from a fast-flowing bottle, they often swallow excess air. That air can build up in the stomach, increase pressure, and push milk back up the esophagus. Paced feeding slows everything down, giving your baby time to coordinate their sucking, swallowing, and breathing more effectively and reduces the chances of overeating or becoming gassy. These are two common triggers for reflux. Using a slower-flow nipple and offering breaks during the feeding can significantly improve comfort, especially in babies prone to spitting up.

Use consistent burping techniques

Burping is a way to reduce internal pressure. When gas becomes trapped in the stomach, it can push stomach contents upward. Burping during and after feeding helps release that gas before it builds up.

Why it helps: Regular burping, especially every one to two ounces, relieves the internal pressure that contributes to reflux and helps keep your baby more comfortable after meals.

Reevaluate your baby’s formula or your maternal diet

For some infants, reflux is more than just a mechanical issue. It may be a reaction to something in their diet. In breastfed babies, this means the mother's diet can sometimes contribute to symptoms. Everything a nursing mom eats is broken down and passed through breast milk, including proteins from common allergens like cow’s milk, soy, eggs, or wheat. These proteins may irritate the baby’s still-developing digestive tract, especially if the infant has an underlying sensitivity or food intolerance.

Why it helps: If a specific food in mommy’s diet is triggering inflammation, removing that food gives the baby’s gut time to heal and reduces the frequency or severity of reflux symptoms. You may notice additional signs beyond spit-up, such as eczema, persistent diaper rash, mucus in stools, or general fussiness during and after feeding.

In formula-fed infants, certain formulas may contain the same problematic proteins. In these cases, your pediatrician may recommend trying a hydrolyzed formula (where proteins are broken down into smaller, more digestible fragments) or a hypoallergenic formula, especially if there’s a suspected or confirmed allergy.

What to consider avoiding

Cow’s milk protein is the most common culprit and often the first food eliminated.
Soy is another frequent irritant, particularly in babies who are also sensitive to dairy.
In some cases, pediatricians may recommend temporarily avoiding eggs, wheat, corn, or nuts, depending on the symptoms.

How to evaluate

Start with a trial elimination under the guidance of your pediatrician. Most elimination diets begin with removing dairy for two to three weeks while observing changes in reflux, stool patterns, skin issues, and overall temperament. If symptoms improve, you may have identified a trigger. If not, further evaluation or more comprehensive elimination may be necessary.

This process takes time, patience, and tracking. A food and symptom journal can be incredibly helpful in identifying patterns and making informed decisions in collaboration with your healthcare provider. Always consult your pediatrician or a pediatric dietitian before beginning or continuing an elimination diet.

Tummy time matters for reflux relief

Tummy time is an essential part of your baby’s daily routine. It plays a critical role in motor development, muscle tone, and postural control. But it also offers an added benefit that many parents may not realize—it can support digestion and help reduce reflux symptoms.

During tummy time, your baby activates the muscles in their neck, shoulders, back, and core. These muscles do more than support movement. They also help regulate internal pressure and contribute to more efficient digestion.

Why it helps: Strengthening these muscle groups makes burping more effective and can reduce post-feeding pressure on the stomach. This may result in fewer reflux episodes and increased comfort after feeding. Tummy time also helps your baby become more comfortable in positions other than lying flat, which can lessen discomfort during awake periods when reflux tends to be more noticeable.

If your baby is already getting regular tummy time, you’re on the right track. If they struggle with it, start small. Try varying the surface by using your chest, a firm blanket, or your lap to keep things comfortable and engaging.

These natural techniques are gentle, accessible, and well-supported by pediatric guidance. While they may not resolve reflux overnight, many families see gradual improvements over days or weeks. The key is consistency. Keep a log of your baby’s feeding patterns, sleep habits, and symptoms as you introduce these changes. That way, you and your care team can track progress and adapt your approach as needed.

Most importantly, know that you’re doing the right thing by responding with care and curiosity. Reflux can feel overwhelming, but with the right tools and support, your baby can feel more comfortable and settled naturally and gently.

When should I take my baby to the pediatrician for reflux?

As a parent, you know your baby better than anyone else. If something feels off, such as when feeding is no longer peaceful, sleep is consistently disrupted, or your baby seems to be in pain, your instincts are worth listening to.

Several signs may suggest your baby’s reflux has moved beyond a normal developmental phase and may require medical attention.

Signs you should have your baby evaluated for GERD

Persistent crying or visible discomfort during or after feeding
Forceful vomiting or spit-up that contains blood or bile
Slowed weight gain or noticeable weight loss
Ongoing refusal to eat or difficulty completing feedings
Frequent coughing, gagging, choking, or breathing issues such as wheezing
Chronic sleep disruption due to discomfort or pain

Your pediatrician will likely begin by reviewing your baby’s medical history, growth trends, and feeding patterns. A thorough physical exam can help rule out other underlying causes. In many cases, your provider will recommend starting with gentle, noninvasive changes to feeding techniques, positioning, or diet.

If symptoms persist or worsen, further evaluation may be necessary. Your doctor may suggest diagnostic tools, such as esophageal pH monitoring, or refer you to a pediatric gastroenterologist for specialized care. In some cases, medications such as H2 blockers or proton pump inhibitors (PPIs) may be prescribed to reduce stomach acid and minimize irritation to the esophagus.

Most pediatricians will begin with the least invasive approach, knowing that reflux in infants often improves naturally over time. With consistent care, close monitoring, and supportive strategies in place, many babies find relief without medication. What matters most is staying attentive to your baby’s signals and working closely with your care team to find the most suitable path forward.

Can a chiropractor help with infant acid reflux?

For parents seeking a gentle, non-invasive approach to managing reflux, pediatric chiropractic care may offer supportive benefits, especially when used in conjunction with traditional feeding and positioning strategies. Chiropractic care does not aim to treat or cure gastroesophageal reflux disease (GERD) directly. Instead, it focuses on supporting the nervous system, musculoskeletal alignment, and digestive function.

How chiropractic care may support infant reflux

The spine plays a central role in regulating communication between the brain and body. In infants, tension or misalignments in the spine, particularly in the cervical (neck) and thoracic (upper back) regions, may affect the function of the vagus nerve, which helps control esophageal tone, gastric emptying, and other digestive processes.

When spinal motion is restricted or imbalanced, it may disrupt this communication. Chiropractors use gentle, specific adjustments to improve alignment, mobility, and function in these regions. For babies experiencing reflux, this may help reduce strain during feeding, promote better coordination between swallowing and digestion, and support calmer, more efficient feeding patterns.

What the research says

A published case study in the Journal of the Canadian Chiropractic Association described the care of an infant with recurrent vomiting and signs consistent with reflux. The infant received chiropractic adjustments over several visits. According to the report, the parents observed improvements in vomiting frequency, feeding behavior, and sleep quality.

This case adds to a growing body of observational evidence suggesting that chiropractic care may help reduce symptoms of reflux in some infants by addressing spinal tension and optimizing nervous system function. However, more controlled studies are needed to fully understand the relationship between chiropractic care and digestive health in infants.

While additional studies are needed to quantify these outcomes, existing research suggests that chiropractic care may:

Help alleviate musculoskeletal tension in infants
Support the function of the nervous system
Reduce stress responses that interfere with digestion

What does an infant adjustment look like?

Infant chiropractic adjustments are gentle, specific, and completely different from those used with adults. The spine plays a vital role in communication between the brain and body. In infants, subtle misalignments in the cervical (neck) and thoracic (upper back) regions may influence the function of the vagus nerve, which helps regulate digestion, including esophageal tone and gastric emptying.

An infant chiropractic adjustment is often a calm and family-centered experience. During the visit, the chiropractor, whether pediatric or chiropractic, will typically guide the parent to lie face up on the table with the infant resting face down on their chest.

The chiropractor then uses gentle fingertip pressure to deliver precise adjustments, no more intense than checking the ripeness of a peach. In some cases, a specialized instrument called an Activator may be used to apply gentle, controlled adjustments with precision.

There is no cracking or forceful manipulation. Most babies remain relaxed throughout the process, and many even fall asleep.

In addition to hands-on care, chiropractors may offer guidance on feeding positions, posture, tummy time, and soothing techniques that can help support your baby’s comfort at home.

Are chiropractic adjustments safe for my baby?

When performed by a trained and licensed chiropractor with experience in pediatric care, spinal adjustments for infants are generally considered safe. Studies of adverse events in infants receiving chiropractic care have found such events to be rare and generally mild. At The Joint Chiropractic, we emphasize open communication with your child’s pediatrician and always recommend a team-based approach to care.

You’re not alone

Caring for a baby with reflux is challenging. But it’s also temporary. With the right support, your baby can feed more comfortably, sleep more soundly, and grow with confidence.

Whether you’re trying lifestyle changes, adjusting feeding routines, or exploring chiropractic care for children and infants, know that you’re not in this alone. Our team at The Joint Chiropractic is here to help you navigate infant reflux with science-backed care, gentle support, and a whole lot of heart.

You’ve got this. And we’ve got you.

Frequently Asked Questions about acid reflux in babies

What are the signs of acid reflux in infants?

Common signs of reflux in infants include frequent spit-up (especially after feeding), fussiness or arching during or after meals, wet burps or hiccups, difficulty sleeping, and interruptions during feeding. Some babies may show discomfort without visible spit-up, a condition often referred to as silent reflux.

How do I know if my baby has GERD or just spits up a lot?

If your baby spits up frequently but remains content, feeds well, and gains weight, it’s likely normal reflux. GERD, or gastroesophageal reflux disease, is diagnosed when reflux causes distress, poor weight gain, feeding refusal, sleep disruption, or respiratory issues. The key difference is the impact on your baby’s comfort, growth, and overall health.

What home remedies can help soothe a baby with reflux?

Several natural strategies can help ease reflux symptoms and make feeding more comfortable for your baby. Try offering smaller, more frequent feeds to reduce pressure on the stomach, and hold your baby upright for 20 to 30 minutes after each meal to allow gravity to assist with digestion. Using a slow-flow bottle nipple and paced bottle feeding can prevent your baby from swallowing too much air, which often contributes to gassiness and spit-up. Frequent burping—during and after feeds—also helps release trapped air and reduce internal pressure.

Daily tummy time, while your baby is awake and supervised, helps strengthen the core and postural muscles that support more effective digestion. For breastfeeding parents, removing common irritants like dairy or soy from the diet may help if food sensitivity is suspected.

Some families also explore gentle pediatric chiropractic care to support overall spinal alignment and nervous system regulation. Chiropractors use light fingertip pressure to address subtle tension in the spine that may affect feeding comfort or digestive function. While it’s not a cure for reflux, this approach may offer added relief when combined with other supportive techniques.

Should I change my baby’s formula or diet for reflux?

Possibly. Some babies with reflux may have sensitivities to common proteins, such as dairy or soy. If your baby shows signs of discomfort, eczema, or mucus in their stools, your pediatrician may recommend trying a hydrolyzed or hypoallergenic formula. Breastfeeding parents may be advised to eliminate certain foods, beginning with dairy. A healthcare provider should guide any dietary changes.

Is reflux harmful to my baby’s development?

Most reflux is not harmful and typically resolves on its own over time. However, if it begins to affect feeding, weight gain, or sleep, it may interfere with development. In these cases, early intervention from your pediatrician can help support growth and prevent complications.

What’s the best sleeping position for a baby with reflux?

Even if your baby has reflux, the safest way for them to sleep is on their back, on a flat and firm surface, without any loose items in the crib. This is part of what many hospitals and pediatricians teach as the ABCs of safe sleep:

Alone
Back
Crib

These guidelines are designed to reduce the risk of sudden infant death syndrome (SIDS) and other sleep-related dangers. That means your baby should sleep alone in their crib or bassinet (not in a bed with adults or siblings), placed on their back for every nap and nighttime sleep, and in a crib or bassinet free of pillows, blankets, bumpers, toys, or sleep positioners.

You may have heard that elevating your baby’s crib mattress can help with reflux. However, the American Academy of Pediatrics (AAP) and pediatric sleep safety experts caution against this. Inclining the mattress or using wedges may increase the risk of your baby rolling into a dangerous position and can lead to accidental suffocation.

Instead of modifying your baby's sleep position, focus on upright time when they are awake. Holding your baby upright for 20 to 30 minutes after each feed can help gravity support digestion. Supervised tummy time and upright snuggling during the day offer additional relief without compromising nighttime safety.

Though it’s tempting to try creative solutions when your baby seems uncomfortable, sticking to safe sleep practices is always the best choice. If reflux is significantly interfering with your baby’s sleep, talk to your pediatrician about strategies that balance comfort with safety.

How does chiropractic care support infant digestive health?

Chiropractic care aims to support the nervous system by gently improving spinal mobility and alignment. In infants, subtle tension in the neck or upper back may influence how the nervous system regulates digestion. Chiropractic adjustments use light touch to reduce that tension, which may help improve comfort and feeding patterns over time.

Can spinal misalignment affect acid reflux in babies?

Potentially, yes. Misalignment or restriction in the upper spine may affect the function of the vagus nerve, which plays a crucial role in regulating esophageal tone and digestion. By addressing these areas through gentle chiropractic care, some babies may experience improved feeding coordination and reduced symptoms of reflux.

When should I seek medical treatment for baby reflux?

Contact your pediatrician if your baby shows signs of discomfort, refuses to feed, has poor weight gain, vomits forcefully, or exhibits respiratory symptoms such as coughing, choking, or wheezing. Persistent sleep disruption or inconsolable crying after meals may also warrant evaluation.

How long does infant reflux typically last?

Most babies outgrow reflux by 12 months of age, as their digestive systems mature and they spend more time in an upright position. For some, improvement comes as early as six months. If symptoms persist beyond the first year or interfere with growth or development, further evaluation may be needed.

The information, including but not limited to text, graphics, images, and other material contained on this page, is for informational purposes only. The purpose of this post is to promote broad consumer understanding and knowledge of various health topics, including but not limited to the benefits of chiropractic care, exercise, and nutrition. It is not intended to provide or be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your chiropractor, physician, or other qualified health care provider with any questions you may have regarding a medical condition or treatment and before undertaking a new health care regimen, and never disregard professional medical advice or delay in seeking it because of something you have read on this page.