Gastroesophageal reflux — also called reflux — is when food and acid from the stomach go back up into the esophagus, and sometimes out the mouth or nose. It's normal for babies to have reflux and some spitting up. Most reflux gets better on its own by the time a baby is 1 year old. Changes in feeding can help. Follow these instructions to care for your baby.

• Burp your baby during and after feeding:
  • When breastfeeding, burp each time you switch breasts.
  • When bottle feeding, burp after your baby drinks 2–3 ounces (60–90 ml).
• Don't overfeed your baby. Ask your health care provider how much your baby should eat and how often.
• Keep your baby in an upright position for 15–30 minutes after feeding time is over. Holding your baby over your shoulder is a good way to do this.
• Put your baby in a car seat only when traveling. Being in a car seat too much can make a baby's reflux worse.
• If the health care provider told you to thicken your baby's formula or breast milk, follow their instructions. You may need to make the hole in the bottle nipple bigger so the thickened feeds can flow.
• Follow the health care provider's recommendations for any changes in your diet (if you are breastfeeding) or your baby's diet.
• Always put your baby to sleep on the back at bedtime and naptimes.
• Don't let anyone smoke near your baby. It can make your baby's reflux worse. If anyone in your house smokes, visit smokefree.gov for advice on quitting or call 800-QUIT-NOW.

Your baby:

• does not seem to be growing
• cries a lot more than usual
• won't eat, or cries and arches away from the bottle or breast during feedings
• coughs, chokes, wheezes, or has trouble breathing
• has forceful vomiting more than a few times in a 24-hour period
• has blood in the poop
• still has signs of reflux after 1 year of age

Your baby throws up blood or bile (a green or yellow liquid).

What causes reflux? Reflux happens because a ring of muscle at the bottom of the esophagus (the tube that runs from the mouth to the stomach) does not close all the way. This ring of muscle is called the lower esophageal sphincter (LES). If the LES does not close all the way, breast milk, formula, food, and fluid from the stomach can come up the esophagus and sometimes out the mouth or nose.

What's the difference between reflux and GERD? Reflux that causes problems like poor growth or damage to the esophagus is called gastroesophageal reflux disease (GERD). GERD is more serious than reflux and might be treated with medicine. Reflux almost always goes away by the time a baby is 1 year old, but GERD is more likely to continue.