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Does your baby have acid reflux? That can be so hard - it's so difficult to watch your child suffer! This in depth, parent friendly guide will answer all your questions about reflux in babies as well as what is the best formula for reflux for your child based on their specific set of circumstances.
Finding the best formula for your baby can be stressful! And if you have a baby that needs a hypoallergenic formula, it can be even more confusing to find the best option that is healthy and organic. For parents with babies who have the added concern of acid reflux, this creates another layer of consideration when trying to find the best formula for your child.
All babies spit up - it's a normal part of infancy. Sometimes though, it may seem like your baby barely keeps anything down! So when do you know if your baby's spit up is something to be concerned about?
Here I'll review what acid reflux is in babies, the differences between GER and GERD, and when you need to be concerned and see a doctor.
I've also outlined the best formulas for your child to help with their reflux based on what you are looking for, as well as what is best for your child based on their specific circumstances.
What is Acid Reflux? (in Babies)
Acid reflux in babies occurs when babies spit up. The food in their stomach moves back up and out their mouth. This is completely normal and common, and will often happen several times a day. There's no need to worry if your child is in otherwise healthy condition, and growing.
Acid reflux becomes a concern if it happens more frequently and is interfering with your child's growth and development.
The Happy Spitter/Milk Reflux (GER)
Sometimes called gastroesophageal reflux or GER, this is a condition in which your child moves contents from their stomach through their esophagus, and out their mouth. This is the normal type of spitting up that occurs in all babies, and may even be called the "happy spitter" or "milk reflux." If your child is a "happy spitter", that means they do not seem upset, or cry after spitting up. There is no appearance of pain, and in some cases they may even feel better after spitting up.
GER often appears after the age of 2-3 weeks and may persist until 9-12 months. It typically disappears after your child's digestive tract has matured. As your child gets older and they have the ability to control their head, sit up, and eat solid foods you will likely see an improvement in your child's spitting up.
Severe Acid Reflux or Silent Reflux in Infants (GERD)
When acid reflux causes other problems it is considered GERD. GERD occurs when the reflux has enough acid that it irritates the lining of the esophagus. If your child exhibits any of the following symptoms, make an appointment with your doctor.
- Refuses to eat
- Isn't gaining weight
- Cries, arches back, looks in pain during feedings
- Blood in stool
- Blood or greenish color in spit up
- Spitting up increases in intensity and frequency. (e.g. the spit-up shoots out of your child's mouth forcefully and multiple times a day).
- Baby's belly is swollen, feels hard, or is distended
- Wheezing and coughing, has difficulty breathing
- Begins spitting up after 6 months of age
Do You Need To Use A Specific Baby Formula For Reflux Or Is Regular Formula Fine?
If you take your child to the doctor regarding their reflux, they may recommend a change to your baby's formula. This is because many formula brands are made with cow's milk, and there is a protein in cow's milk that can aggravate reflux in some children.
If your child is on this type of regular cow's milk formula, and their reflux is caused by an allergy to this milk protein, it will be necessary to make a change. The question is, what formula should you switch to?
You can choose from a hypoallergenic formula (where the cow's milk proteins are broken down) or a formula specific for reflux in babies. There are also many types of formulas that are not made particularly for acid reflux, but do not contain cow's milk. In that case, it may be okay to use a formula that isn't designed for acid reflux, but will still help alleviate your baby's condition.
Will Formula Help With reflux?
In some cases, making a switch from one formula to another will help with reflux. For example, anti-reflux formula or thickening formula may reduce the frequency of reflux. Note: it is always advised to consult your pediatrician before starting thickening formulas or making a change to a different type of formula. Thickening formulas are premixed with rice starch to thicken the formula. They may be called "anti-reflux" or "spit-up" formulas.
Is Breast Milk Better For Reflux In Infants?
Not necessarily. Research has shown that breastfeeding in general reduces the risk of your baby developing reflux. However, if your baby has an allergy to something in your breastmilk, and eliminating allergens from your diet hasn't worked or isn't feasible, then you may need to switch to a thickening formula or an "anti reflux" formula.
What's Better For Acid Reflux: Ready Made Formula (Ready to Feed Formula) Or Powdered Formula?
When it comes to choosing ready made formula, powder, or concentrated liquid formula, there isn't one that is better than the other for reflux. Deciding to go with powder, concentrated liquid, or ready made is more about the convenience for you as the parent. Powder is the least expensive, while ready made is the most expensive, and the concentrated liquid falls somewhere in the middle. Some ready to feed formulas will have more stabilizers and preservatives than their powdered formula counterparts, making them less ideal from an ingredients standpoint.
Choose a formula based on what is best for your child and their specific circumstances. For example, if your child has an allergy to the protein in cow's milk it does not matter if you use ready made, powder, or concentrated. What matters is that you choose a formula that works for your lifestyle and alleviates your baby's symptoms.
Best Formula for Reflux
Now that most of your questions about reflux are covered, let's focus on what is the best formula for reflux. Here I'll review several different types of formulas.
- Reflux/Spit Up and Colic Formula
- Pre-Thickened Ready Made Formula for Reflux
- Hypoallergenic Formula for Reflux
- Goat Milk Formula for Reflux
- Organic Formula for Reflux
The Best Formula for Reflux, Spit Up and Colic
The Best Pre-Thickened, Ready to Feed Formula for Babies with Acid Reflux
The Best Hypoallergenic Formula for Infants with Reflux
The Best Goat Milk Formula for Acid Reflux
The Best Organic Formula for Acid Reflux
AR and HA formulas technically aren't organic because of the modified proteins and added ingredients needed to make the formula easier to digest. Therefore, there are no formulas that can be recommended that are organic and formulated specifically for babies with reflux.
That said, there are organic formulas like Holle A2 or Kendamil Goat that aren't formulated for reflux, but could still help with reflux if the cause of your baby's reflux is a sensitivity to A1 cow's milk protein.
Formula & Reflux FAQs
Which kind of bottle is best for reflux?
Choosing the best bottle for reflux will go a long in helping your baby feel more comfortable during feeding time. I recommend Dr. Brown's Original Bottle. It's recommended by pediatricians, keeps the nutrients inside the milk, and prevents your baby from ingesting air through a patented vent system. When feeding your baby, be sure to keep milk in the nipple to avoid your baby gulping down extra air.
What size bottle nipple should I use?
When it comes to reflux, smaller is better. Although you don't want the nipple to be so small that your baby becomes frustrated. Larger nipple sizes can cause too much milk to be gulped down at a time. When your baby has too much milk in his/her stomach, they are more likely to experience reflux.
Nipple recommendations are determined by age, but it is not always the best way to go when choosing the best nipple size for your child.
Here are the recommendations, based on age.
Premature/Premature
0+/level 1.
3+/Level 2
6+/Level 3
9+/Level 4 or Y Cut
Knowing when to change the nipple size will ultimately depend on your baby, and not simply their age. Each child has their own feeding style. But there are a few clues that your baby may need to change their nipple size. If the flow isn't fast enough for your baby, they will give you a few signs, such as:
It's taking them longer to finish their bottle.
They seem fussy when eating.
Your child falls asleep while eating.
When it comes to reflux, you want to be careful not to offer your baby a nipple that is too big, and causes the flow to be too fast. It's better to err on the side of a smaller nipple size than larger.
How much formula should I feed my infant?
The amount of formula your baby's tummy can hold will depend on their age. When they are a newborn their stomachs are so small they can only hold about 2 ounces of milk at a time. But once they mature they are able to hold more. At about 2 months your baby should be able to hold about 4-5 ounces at each feeding. By 4 months old your baby may be able to drink as much as 6 ounces at each feeding. At 6 months your baby may be able to hold up to 8 ounces.
Eating habits may change slightly as your infant is growing. As your baby gets older, they will be able to eat more at each feeding, and go longer between feedings.
What do doctors prescribe for acid reflux in babies?
Your doctor may recommend that you decrease the amount of milk at each feeding, while increasing the frequency. This is because babies are more likely to have reflux when their tummies are too full.
Feed your baby upright and keep them upright for 30 minutes to decrease likelihood of acid coming back up
Check nipple size to make sure it is not too big. Your doctor may recommend going down a size to prevent your baby from getting too much milk too fast.
Try thickened formula or breast milk by adding a bit of rice cereal to formula or breast milk to reduce spitting up.
Burping more often will help your child release air, and reduce spitting up. If formula feeding, burp your baby after every 2 ounces.
If lifestyle changes don't help your doctor may recommend medication or surgery, but this is very unlikely.
Medications such as Prevacid which has been used to reduce acid in the stomach have not shown to make any considerable difference in infants.
Surgery will only be recommended by your doctor if reflux causes severe breathing problems or failure to grow.
Does formula make reflux worse?
The answer is: It depends. If your baby has reflux due to a milk protein allergy, then choosing a non-hypoallergenic formula could make reflux worse (while choosing an anti-reflux or hypoallergenic formula may make reflux better).
If you are already breastfeeding your baby, and your baby is showing signs of reflux, your baby's reflux may be due to an allergy to a component of your breastmilk. In that case, the first step is to try to identify the allergen and eliminate it from your diet to see if your baby's reflux improves. If it doesn't, then switching to an anti-reflux or hypoallergenic formula may make the reflux better.
How do you soothe a baby with acid reflux?
- Feed your baby in an upright position
- Increase frequency of feedings, and decrease the amount you are feeding your baby.
- Make sure to burp your baby after every 2 ounces.
- Put your baby to sleep on his/her back.
What age does reflux peak in babies?
Reflux in babies usually begins at about 2-3 weeks of age, and peaks at 4-5 months. If your baby was born at full term, most babies resolve their reflux challenges by 9 months old.
Does gripe water help with reflux?
While using gripe water may be tempting, and seems like it may work to help ease your baby's reflux, there is no scientific evidence that it makes a difference.
Ingredients vary, but most container fennel, ginger, peppermint, lemon balm, chamomile, and sodium bicarbonate. The World Health Organization discourages giving your baby anything besides breast milk or formula before the age of 6 months, as it increases the likelihood of bacteria infection, allergies, and stomach problems.
Does tummy time help with reflux?
Tummy time is important to develop your baby's back muscles so that they can sit up. While it's important to schedule as much tummy time as possible for your child, it's important to do so before feedings. Babies with reflux will not tolerate tummy time as well as those without. But it's still important to do it in short bursts of time so that your child can develop their back muscles. Later, they will be able to sit up-right, which will help with their reflux.
What Else Can Help A Baby With Reflux?
Paced Bottle Feeding
Paced bottle feeding is simply the idea of providing your baby more frequent feeding with less milk at each feeding. This helps prevent your baby from filling his/her tummy too full and causing reflux.
Using Baby Probiotics
Probiotics may help prevent and soothe acid reflux in babies. However, it can take 2-3 weeks to be effective. When looking for a probiotic try Gerber Soothe or BioGaia.
Sleeping On an Incline
This one is somewhat controversial. Positioning your baby to sleep on an incline can help with reflux, as long as the entire body is at an incline, and not just their head and neck. This allows for gravity to help pull acid down.
However, AAP policy calls for infants to sleep on their back, on a separate, flat and firm surface without any bumpers, bedding or stuffed toys.
They do not recommend products such as the Rock 'n Play or Babocush. So the only way for your baby to truly sleep on an incline safely is in a baby carrier or while you're holding them - which isn't really feasible most of the time!
