Gastroesophageal Reflux Disease (GERD) in Infants and Children

Brooke Phillips, CWCMS
Editor | Shield HealthCare
04/18/24  11:01 AM PST
GERD in infants and children


Gastroesophageal reflux (GER) happens when your stomach contents come back up into your esophagus. People of all ages have GER once in a while, and GER often happens without causing symptoms. In both adults and children, GER may cause heartburn, also called acid indigestion. In infants – babies under 12 months old – GER commonly causes regurgitation (stomach contents coming back up through the esophagus and into the throat or mouth) and spitting up.

Gastroesophageal reflux disease (GERD) is a more severe and long-lasting condition in which GER symptoms are repeated frequently; they are distressing; and they have the potential to lead to complications. GERD is more common in premature infants and infants with certain health conditions, such as:

  • conditions that affect the lungs, such as cystic fibrosis
  • conditions that affect the nervous system, such as cerebral palsy
  • hiatal hernia, a condition in which the opening in the diaphragm lets the upper part of the stomach move up into the chest
  • previous surgery to correct esophageal atresia

GERD is easier to diagnose in an adult or child who can clearly communicate. Infants are unable to communicate the scope of the condition, making it difficult for doctors and caregivers to determine the scope of an infant’s reflux, including the degree of infant distress and whether it is caused by GER or by something else.

GERD symptoms

The symptoms of GER and GERD can vary from “spitting up” to severe difficulties with vomiting, esophageal inflammation, pain, and lung problems.

Each child may experience GERD differently. Common symptoms include:

  • heartburn
  • chest pain
  • bringing food up into the mouth
  • bad breath
  • stomachache or pain during or after eating
  • fussiness around mealtimes
  • hiccups
  • gagging or choking
  • frequent cough, coughing fits at night, or both
  • wheezing
  • vomiting
  • inability to gain weight
  • gastrointestinal bleeding

When infants have acid reflux or GERD, they may be fussy or arch their backs during feedings, or make abnormal movements of the neck and chin. They may frequently choke, gag, have problems swallowing, and even vomit. They may not gain weight well or refuse to eat.  They may be irritable with spitup/regurgitation, and have an unexplained cough or wheeze. If your child has these symptoms – especially if they aren’t gaining as much weight as they should – they should be evaluated by their pediatrician.

When does spitting up need treatment?

Spitting up is a normal occurrence for young infants, affecting up to 85% of all babies. As long as your child is growing well and not developing other problems, such as breathing difficulties, the condition needs no treatment and will typically resolve on its own with time. However, if your child vomits frequently, has poor weight gain and growth, has pain that interferes with normal activities, or develops inflammation (esophagitis), ulcers (sores) in the esophagus, or respiratory problems, they should be seen and evaluated by their pediatrician.

Poor weight gain

Infants with GERD may spit up their food often or refuse to eat. These symptoms can cause an infant to gain less weight than expected or to lose weight (sometimes called “failure to thrive”). Slow weight gain can interfere with a child’s healthy development, especially during the first 12 months when their brain is developing quickly.


Esophagitis is inflammation in the esophagus. Esophagitis may cause painful ulcers in the lining of the esophagus, which can bleed and lead to anemia. Over time, chronic esophagitis may increase the chance of developing esophageal stricture and Barrett’s esophagus, which involves abnormal cells in the esophageal lining.

Respiratory complications

Some infants with GERD also have complications that can affect their lungs. If a child’s stomach contents move up the esophagus and spill over into the windpipe, it can cause a variety of complications including asthma and pneumonia. Respiratory complications range from wheezing and chronic cough to bronchial asthma, bronchitis, pneumonia and interstitial fibrosis.

How common is GERD?

Researchers estimate that approximately one in five adults suffer from GERD. While GER is common in infants (70-85% of infants regurgitate daily by 2 months old), experts aren’t sure how common GERD is in infants because the condition is difficult to diagnose. Doctors often diagnose gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD) in infants by reviewing their symptoms and medical history. If symptoms don’t improve with lifestyle changes, doctors may recommend medical tests.

What causes GERD in children?

Any infant can have GERD. GERD is more common in premature infants and in infants with certain health conditions that affect the esophagus, nervous system, or lungs.

In infants and children, the lower esophageal sphincter (LES) relaxes, letting gastric fluid escape into the esophagus. Although this relaxation is normal, it happens more frequently in some children. The diaphragm and stomach both support the LES, so when one or both aren’t working properly, reflux can intensify. If your child’s esophagus doesn’t move normally, any reflux that enters the esophagus isn’t cleared well, putting children at risk for GERD symptoms and esophageal damage.

GERD symptoms can sometimes have other, unrelated causes, so it’s important that your child sees a clinician who is not only able to help to make an accurate diagnosis of GERD but who also explores the possibility of health problems other than GERD. If these sympoms have a different cause – such as an allergy, for example – your child may be able to avoid unneccessary treatment.

For more information, visit the National Institute of Diabetes and Digestive and Kidney Diseases, and/or contact your child’s pediatrician.

Resources include:

Recent Nutrition

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