Key takeaways

  • For infants experiencing frequent spit-up, accompanied by symptoms such as irritability or poor weight gain, medication may be necessary to manage gastroesophageal reflux disease (GERD).
  • Several types of drugs, including mucosal surface barriers and gastric antisecretory agents, can help reduce stomach acid production and protect the esophagus in infants with GERD.
  • Due to potential risks such as increased infections and long-term effects like asthma or bone fractures, it’s essential to consult with a pediatrician to determine if GERD medication is necessary and to explore home remedies, including frequent burping and keeping the baby upright after feeding.

GERD occurs in infants for several reasons, but it’s usually because the lower esophageal sphincter, which closes the esophagus off from the stomach, may not be mature enough to close properly.

Just like GERD in adults, GERD in infants can be managed several ways. Your doctor may first recommend that you make changes in feeding, such as burping your infant more frequently during feeds and holding them upright for a half hour after each feeding.

Note: While keeping a baby upright after feeding can help, it’s critical that babies sleep flat on their backs on a firm surface. Propping up a crib mattress or using inclined sleepers is not safe and increases the risk of sudden infant death syndrome (SIDS).

If changes in feeding don’t seem to help your baby, your doctor may recommend medication.

There are several types of medication that may help relieve GERD symptoms in your little one. Your child’s doctor may prescribe these drugs if they believe the benefits outweigh the risks.

Gastric antisecretory agents

Gastric antisecretory agents are the most commonly prescribed medication for infants. They help reduce the amount of acid the stomach produces. There are two kinds of antisecretory agents that help reduce the acid in the stomach. These are histamine H2 receptor antagonists (H2RAs or H2 blockers) and proton pump inhibitors (PPIs).

H2RAs

Famotidine (Pepcid) is generally considered safe for babies. You can give a liquid form of the medication to infants and use chewable tablets for children. This medication starts working quickly, so it’s useful to have in a pinch. However, H2RAs aren’t usually recommended for long-term use in infants.

PPIs

PPIs are another class of drugs that reduce the amount of acid in the stomach. While most PPIs are officially approved for children over 1 year of age, esomeprazole (Nexium) is FDA-approved for infants as young as 1 month for specific conditions like erosive esophagitis.

Other PPIs, like lansoprazole (Prevacid), are sometimes used off-label if a pediatrician determines the benefits outweigh the risks. (With off-label use, a drug is prescribed for a condition it hasn’t been approved to treat.)

PPIs are generally more effective than H2RAs and are better for healing the esophagus from gastric secretions. Experts recommend using the smallest possible daily dose for infants.

Mucosal surface barriers

Mucosal surface barriers, or foaming agents, help protect the surface of the esophagus from stomach acid.

One example is Gaviscon Infant, which is widely used in the UK and Europe. (This specific version isn’t commonly available or approved by the Food and Drug Administration [FDA] in the United States.) It’s an alginate, which works by forming a physical “raft” on top of stomach contents to keep them down. The main side effects of this drug are constipation and diarrhea.

There are some concerns about reflux medications being overprescribed. It’s important to keep in mind that most babies will spit up from time to time, and they don’t always require medication.

Two-thirds of infants experience gastroesophageal reflux. The American Academy of Pediatrics recommends against the use of acid suppressants unless infants have other symptoms of GERD.

Acid suppressant medications have been linked to a higher number of serious infections, and babies who take them are more likely to develop an infection that includes diarrhea. This is because stomach acid is one of the body’s natural defenses against germs. By reducing that acid, these drugs can make it easier for bacteria to cause pneumonia or gastrointestinal infections like C. diff.

There may also be long term effects from taking acid suppressants. Infants who take these medications are more likely to develop asthma and have a bone fracture later in life compared with children who do not take them. (Prolonged use of PPIs can make it difficult for the body to absorb calcium, which may explain the increased risk of bone fractures later in life.)

Because of the potential health risks, it’s generally recommended that the lowest effective dosage of reflux medication be used for the shortest amount of time necessary. It’s important to work closely with your child’s doctor to understand how medications prescribed for your infant may impact their body now and in the future.

Before trying medication, it may be a good idea to try home remedies. Additional ways to help control GERD symptoms besides medication include:

  • burping your little one more often during feeds to release trapped gas
  • feeding just a few ounces of breastmilk or formula at a time to keep their stomach from becoming too full
  • keeping the baby upright for 20 to 30 minutes after feeds while keeping them awake and supervised
  • trying a different formula (but discuss this with a pediatrician first)
  • discussing with your doctor the use of anti-reflux (AR) formula
  • adding a small amount of infant cereal to bottles to help the milk stay down

Most babies outgrow reflux by their first birthday without needing any medication at all as their digestive system matures.

If your baby is spitting up frequently and experiencing symptoms like poor weight gain, prolonged coughing, and discomfort, there are a variety of medications that can help control their stomach acid and protect their esophagus. However, it’s important to also consider the potential side effects and other risks associated with these drugs.

Before starting them on medication, it’s important to speak with a pediatrician about other changes you can make to your child’s feeding routine. More frequent burping and keeping your baby upright after feeds may help decrease your baby’s discomfort and minimize the need for drugs.

Disclaimer: While Healthline strives for factual, comprehensive, and current information, this article is not a substitute for a licensed healthcare professional’s expertise. Always consult a doctor before taking or discontinuing any medication. Drug information is subject to change and may not cover all uses, directions, precautions, warnings, interactions, reactions, or adverse effects. The lack of a warning does not guarantee a drug’s safety, effectiveness, or appropriateness for all patients or specific uses. Learn more about our approach to content integrity.