What is the treatment for GER?

The treatment for reflux 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 your health care provider may suggest different ways of handling feedings. For example, smaller quantities with more frequent feedings can help decrease the chances of regurgitation. If a food allergy is 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, your health care provider may suggest a trial of medication to decrease the amount of acid in the stomach. Any potential complications related to the medication will be explained. However, most infants don’t 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, also called H2-receptor agonists. These drugs help keep acid from backing up into the esophagus. H2-blockers are often used to treat children with GER 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 is proton-pump inhibitors (PPIs), which block the production of stomach acid. PPIs include

• esomeprazole (Nexium)
• omeprazole (Prilosec)
• lansoprazole (Prevacid)
• rabeprazole (Aciphex)
• pantoprazole (Protonix)

* The authors of this fact sheet do not specifically endorse the use of drugs for children that have not been tested in children (“off label” use). Such a determination can only be made under the recommendation of the treating health care provider.

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.

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