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Use of special formulas, food thickening, small meals,
and medications in the treatment of GER

What is the treatment for GER?

The treatment for Gastroesophageal Reflux (GER) depends on an infant’s symptoms and age. Some babies may not need treatment because GER often resolves by itself. Healthy babies may only need their feedings thickened with cereal and to be kept upright after eating. Overfeeding can aggravate reflux, so smaller quantities with more frequent feedings can help decrease the chances of regurgitation. If food intolerance or allergy are suspected, you may be asked to change the baby’s formula. Breastfeeding mothers may be asked to change their own diets for 1 to 2 weeks. If a child is not growing properly, higher-calorie food or tube feeding may be recommended.

When an infant is uncomfortable, has difficulty sleeping or eating, or does not grow, a trial of medication to decrease the amount of acid in the stomach may be appropriate. However, most infants do not need medication and outgrow reflux by 1 or 2 years of age.

If medication is needed, treatment will often start with a class of medications called H2-blockers. These drugs reduce the amount of acid that the stomach produces and are often the drug of choice for infants because they come in liquid form. H2-blockers include:

cimetidine (Tagamet)

ranitidine (Zantac)

famotidine (Pepcid)

nizatidine (Axid)

A second class of medications often used to reduce stomach acid are Proton-Pump Inhibitors (PPIs), which block the production of stomach acid. PPIs include:

esomeprazole (Nexium)

omeprazole (Prilosec)

lansoprazole (Prevacid)

rabeprazole (Aciphex)

pantoprazole (Protonix)

Specific Instructions for Infants with GER

	If you feed your baby with a bottle, add up to 1 tablespoon of rice cereal to 2 ounces of infant milk. You can add cereal to expressed milk if you are breastfeeding. If the mixture is too thick for your baby, you can change the nipple size or cut a little “x” in the nipple.
	Burp your baby after he’s consumed 1 or 2 ounces of formula. For breast-fed infants, burp after feeding on each side.
	Do not overfeed. Talk with your infant’s doctor or nurse about the amount of formula or breast milk that your baby is consuming.
	When possible, hold your infant upright in your arms for 30 minutes after feedings.
	Infants with GER should usually sleep on their backs, as is suggested for all infants. Rarely, a physician may suggest alternative sleep positions.

Points to Remember

	GER occurs when stomach contents back up into the esophagus.
	GER is common in infants but most grow out of it.
	In infants, GER may cause spitting up, vomiting, coughing, poor feeding, or blood in the stools.
	Treatment depends on the infant’s symptoms and age and may include changes in eating and sleeping habits. Medication may also be an option. Only rarely and in severe cases is surgery required.