Feeding a Baby with Reflux: Tips and Strategies

Feeding a baby with reflux can feel like an endless challenge—feedings that end in crying and spitting up, a baby who seems uncomfortable or refuses to eat. While most babies spit up, reflux becomes a concern when it causes distress or affects growth. Understanding feeding strategies can make a significant difference in your baby's comfort and your sanity.

Understanding Reflux in Babies AAP

First, let's clarify what we're dealing with.

Normal spit-up vs. reflux:

• Almost all babies spit up some
• "Happy spitters" are fine—growing well, not bothered
• Reflux (GER) becomes GERD when it causes problems

What's happening:

• Lower esophageal sphincter is immature
• Stomach contents flow back up
• Most babies outgrow this by 12-18 months
• Peak is usually around 4 months

Signs of problematic reflux (GERD):

• Frequent, forceful vomiting
• Refusal to feed or distress during feeding
• Poor weight gain
• Arching back and crying during/after feeds
• Chronic cough or respiratory issues
• Blood in spit-up (see doctor immediately)

Feeding Position Strategies AAP

How you hold baby during feeding matters significantly.

During feeding:

• Hold baby upright or semi-upright (30-45 degree angle)
• Avoid horizontal feeding position
• Keep baby's head higher than stomach
• Support head and body well

After feeding:

• Keep baby upright for 20-30 minutes after feeds
• Don't put baby down flat immediately
• Babywearing can help keep baby upright
• Avoid car seats or bouncy seats that create stomach pressure

Sleeping position:

• Back to sleep is still safest (even with reflux)
• Never put baby on stomach to sleep for reflux
• Don't use wedges or positioners (unsafe)
• Slightly elevating head of crib may help (put books under crib legs)

Feeding Frequency and Amount AAP

How much and how often to feed can make a difference.

Smaller, more frequent feedings:

• Large volumes stretch the stomach
• Stretched stomach = more reflux
• Offer smaller amounts more often
• Baby may need to eat every 2 hours instead of every 3

Don't overfeed:

• Watch for fullness cues
• Pressure to finish bottles worsens reflux
• Burp frequently during feeds
• Let baby set the pace

Adequate total intake:

• Even with smaller feeds, baby needs enough overall
• Track wet and dirty diapers
• Monitor weight gain
• Work with pediatrician on appropriate amounts

Breastfeeding and Reflux AAP

Breast milk is often easier for reflux babies to digest.

Breastfeeding advantages:

• Breast milk digests faster
• May cause less irritation
• Feeding positions can be adjusted
• Can offer both breasts for smaller amounts each

Breastfeeding adjustments:

• Feed on one breast at a time (less overfeeding)
• Express some milk first if flow is fast
• Try laid-back breastfeeding position
• Feed before baby is desperately hungry

Maternal diet considerations:

• Some babies react to dairy or other foods in mom's diet
• Elimination diet may help some babies
• Talk to pediatrician before eliminating foods
• Most breastfed reflux babies don't need dietary changes

Bottle Feeding and Reflux AAP

Formula-fed babies have specific considerations.

Formula considerations:

• Some babies do better on different formulas
• Thickened formulas (AR formulas) can help
• Hydrolyzed formulas for suspected allergies
• Don't switch formulas repeatedly without medical guidance

Bottle technique:

• Use paced feeding method
• Keep nipple full of milk (not air)
• Use slow-flow nipples
• Take breaks during feeding
• Hold bottle at angle that minimizes air intake

Anti-reflux (AR) formulas:

• Thickened with rice starch
• Stays down better in stomach
• Use only if recommended by doctor
• Don't add rice cereal to regular formula yourself

Thickening Feeds AAP

Some doctors recommend thickening formula or expressed breast milk.

What to know:

• Should only be done under medical supervision
• Usually involves adding rice cereal to formula
• Requires larger nipple hole
• Not recommended as first-line treatment anymore
• AR formula is safer than DIY thickening

Risks of improper thickening:

• Can add too many calories
• May affect bottle nipple flow
• Aspiration risk if too thick
• Better to use commercial AR formula

Burping Techniques AAP

Getting air out helps reduce reflux.

When to burp:

• During feeds (every 1-2 oz for bottle)
• After switching breasts
• After feeding
• When baby seems uncomfortable

Effective burping positions:

• Over shoulder
• Sitting on lap with support under chin
• Face-down on lap
• Try different positions if one doesn't work

Tips:

• Be patient—some babies take longer to burp
• Gentle but firm patting or rubbing
• Don't force—if no burp after a few minutes, move on
• Some babies don't burp much and that's okay

Recognizing True Reflux vs. Normal Behavior AAP

Many things get blamed on reflux that aren't.

Normal baby behaviors (not necessarily reflux):

• Spitting up that doesn't bother baby
• Fussiness in the evening (may be normal)
• Crying after feeding (can be many causes)
• Wanting to eat frequently

More likely to be reflux:

• Arching back and crying during feeds
• Refusing to eat despite being hungry
• Wet burps with apparent discomfort
• Poor weight gain despite adequate intake
• Chronic cough or breathing issues

When to See the Doctor AAP

Some situations require medical attention.

Call your pediatrician if:

• Baby isn't gaining weight
• Refuses to eat or eats very little
• Blood in spit-up or stool
• Green vomit
• Appears to be in significant pain
• Breathing problems
• You're concerned about feeding

What doctor might recommend:

• Diet changes (for breastfeeding mom or formula switch)
• Medication for severe cases
• Testing to rule out other issues
• Referral to specialist if needed

Medications:

• Usually not first-line treatment
• Acid-reducing medications for confirmed GERD
• Have potential side effects
• May be appropriate for some babies

Living with a Reflux Baby AAP

Practical strategies for daily life.

Be prepared:

• Always have burp cloths, extra clothes
• Protect furniture and carpets
• Accept that spit-up is your new normal
• Keep sense of humor when possible

Manage your stress:

• Reflux is stressful for parents
• Get support when possible
• It does get better with time
• Most babies outgrow it by 12-18 months

Communicate:

• Tell caregivers about feeding strategies
• Share techniques with partners
• Advocate for your baby at doctor visits
• Connect with other reflux parents

The Bottom Line

Feeding a baby with reflux requires patience and strategy. Position baby upright during and after feeds, offer smaller amounts more frequently, and burp often. While most reflux improves by 12-18 months, see your pediatrician if baby isn't thriving or seems in significant distress. AAP

Remember:

• Upright position during and after feeding
• Smaller, more frequent feeds
• Burp frequently
• Don't overfeed
• Most babies outgrow reflux

Clara is here when you need support with your reflux baby's feeding challenges.