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Infant Reflux: Root Cause Matters

Updated: Oct 3, 2023

Is baby spitting up? What's normal?

All babies spit up, some more than others. This occurs when the lower esophageal sphincter relaxes, allowing stomach content to backflow into the esophagus, throat, mouth, and sometimes nose. Occasional small volumes of spit up is normal while baby's body is maturing. Infant reflux peaks at 2-4 months, and should resolve by 12 months. This alone may not be cause for concern. However, further investigation is warranted if accompanied by:

  • Frequent, large volumes of spit-up that are painful

  • Inconsolable crying or colic

  • Torticollis

  • Arching back, stiff

  • Crying during/after a feeding

  • Poor feeding or weight gain

  • Abdominal discomfort

  • Respiratory symptoms

  • Sleep disturbances

Common Causes of Infant Reflux

Food protein reaction:

  • allergy

  • sensitivity

  • intolerance

Swallowing air, aerophagia. Due to:

  • poor latch

  • oral dysphagia

  • ankyloglossia or tongue tie


  • breast

  • bottle

Body Tension:

  • In utero position

  • Birth trauma

  • Positional torticollis

Gut Dysbiosis

  • an imbalance of gut flora.


  • Immature tone of digestive system

In rare instances, baby may have a more serious medical condition, such as pyloric stenosis, esophageal atresia, or hiatal hernia, etc.

Treating infant reflux depents on root cause, and may require referrals and collaborative care. Start by working with your pediatrician to review symptoms. Referrals may include:

  • Lactation Consultant: Review of mother and infant health history, assess latch and feeding, investigate symptoms suggestive of protein reaction, gut dysbiosis.

  • Feeding Therapist: assess oral function, dysfunction, and screen for tethered oral tissues/tongue tie.

  • Bodyworker: Address tension, optimize nervous system and digestive function.

  • Registered Dietitian: Explore maternal elimination diet and

  • Pediatric Gastroenterologist: GI testing, motility

  • Pediatric Allergist

  • Pediatric ENT

Other Things to Know about Infant Reflux:

Cow's milk is the leading cause of food protein-induced reflux (Meyer, 2019)

Allergy testing has a high false positive/negative rate in infants. Therefore, guided diet elimination is current standard of care (Rajani, 2020).

Thickening breastmilk/formula is an antiquated practice for managing reflux, and using rice cereal increases risk of constipation and excessive weight gain (Abdulezer, 2020. Gambino, 2008).

Starting solids before 6 months due to reflux is not advised. Both, the World Health Organization, and American Academy of Pediatrics recommend starting solids at 6 months to "optimize growth, development, and health." (WHO)

If your infant is experiencing reflux symptoms, work with your healthcare team to determine root cause. At Nourish Therapy, we support families in exploring gut health, food protein reactivity, aerophagia and oral motor skills, as well as body tension. Schedule a phone consultation if you have concerns.


SIEGEL, S.. 2016. Aerophagia Induced Reflux in Breastfeeding Infants With Ankyloglossia and Shortened Maxillary Labial Frenula (Tongue and Lip Tie). International Journal of Clinical Pediatrics, North America, 5, apr. 2016. Available at: <>.

Bess et Al 2022. Prevalence of Gastroesophageal Reflux Disease in Infants With Congenital Muscular Torticollis: A Prospective Cohort Study. Pediatr Phys Ther. 2022 Apr 1;34(2):180-183. doi: 10.1097/PEP.0000000000000883. PMID: 35385449.

Meyer, R, Chebar Lozinsky, A, Fleischer, DM, et al. Diagnosis and management of Non-IgE gastrointestinal allergies in breastfed infants—An EAACI Position Paper. Allergy. 2020; 75: 14–32.

Jeong, S. 2022. Factors influencing development of the infant microbiota:

from prenatal period to early infancy Clin Exp Pediatr Vol. 65, No. 9, 439–447, 2022

Gulati IK, Jadcherla SR. 2019. Gastroesophageal Reflux Disease in the Neonatal Intensive Care Unit Infant: Who Needs to Be Treated and What Approach Is Beneficial? Pediatr Clin North Am. 2019 Apr;66(2):461-473. doi: 10.1016/j.pcl.2018.12.012. Epub 2019 Feb 1. PMID: 30819348; PMCID: PMC6400306.

Gambino, J. 2018. Reflux 101: a parents guide to gastroesophageal reflux. 1st ed.

Abdulezer A, Mooney P, Besner ME, Laniel S, Milton S, Labelle C, Sant'Anna GM, Sant'Anna A. Xanthan- and Rice Cereal-Based Thickeners in Infants: A Multidisciplinary Single-Center Experience. JPGN Rep. 2022 Apr 8;3(2):e190. doi: 10.1097/PG9.0000000000000190. PMID: 37168924; PMCID: PMC10158338.

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1 comentario

Argie Pitsakis
Argie Pitsakis
03 oct 2023

This was a very helpful article. Thank you for including the references!

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