GERD in Infants: How Symptoms Differ from Adults

Written by: Jennifer House, MSc, RD

Updated: October 29th, 2025

When you think of acid reflux, you probably picture heartburn after a spicy meal. But infants can experience acid reflux, too, even without consuming any solid food! While spit-up is a normal part of infancy, frequent or severe symptoms may signal something more.

Gastroesophageal Reflux Disease (GERD) in infants is surprisingly common and very different from what adults experience. Understanding the difference between normal acid reflux and GERD is key for early intervention.

In this article, you’ll learn how GERD shows up in babies, how it’s different from adult reflux, and what parents can do to help. Let’s start with the basics…

What Is GERD? How Does It Differ from Heartburn and Acid Reflux?

Gastroesophageal reflux (GER), also known as “acid reflux,” occurs when the contents of the stomach pass back up into the esophagus. This can happen with or without vomiting.

Jen House, RD, shares: “As a mom of three, I remember always needing to keep a cloth handy over my shoulder when burping my babies—milk would often come back up after a feed! Reflux is quite common in young infants because the muscles at the top of their stomachs aren’t yet strong enough to keep the milk down.”

GER affects 40% or more of infants, typically beginning around eight weeks old. This usually improves as children grow, start to eat solids, sit up for longer periods, and develop stronger abdominal muscles. GER typically resolves in most infants by the time they are one year old.

Reflux is usually nothing to be concerned about in babies, even if it causes vomiting. Babies may be called “happy spitters” if they are not bothered by reflux.

Gastroesophageal reflux disease (GERD) is more serious and is diagnosed when GER leads to symptoms that negatively affect your day-to-day life or require medical treatment.

Approximately 10-20% of the adult population in Western countries struggles with GERD. In infants, the prevalence of GERD decreases with age, from 25% at 1 month to under 2% by 12 months of age.

While acid reflux or GERD may be confused with heartburn, heartburn is just one of the common symptoms of GERD. Heartburn is a burning sensation from above the stomach to the esophagus.

In addition to heartburn, adults with GERD often experience symptoms such as:

A sour taste in your mouth (from stomach acid)
Discomfort after meals
Nausea
Hoarseness, throat clearing, chronic cough, laryngitis,
Worsening asthma
Chest pain
Sleep apnea

Infants, however, can’t describe their GERD symptoms. And GERD in infants doesn’t usually include the classic burning sensation we associate with heartburn. Instead, it shows up as feeding difficulties, irritability, or poor growth.

Signs and Symptoms of GERD in Infants

Spitting-up is normal for many babies, especially under 12 months. A baby with reflux typically experiences normal growth, minimal feeding difficulties, and is unbothered by the symptoms.

In contrast, a baby with GERD will be uncomfortable, and it may manifest as colic. While GERD is not the only reason for colic, it can lead to excessive crying and fussiness in babies.

There is an increased frequency and severity of GERD among children with cow’s milk protein allergy, neurologic impairment and developmental delay, including children with cerebral palsy and in premature infants.

But how do you know if your baby has GERD? Signs and symptoms of GERD in infants often begin before the baby is 8 weeks old and can include:

Frequent or forceful spit-up or vomiting (6+ times/day)
Arching the back or crying during or after eating
Weight loss or poor growth
Refusal to eat
Chronic gagging or choking
Wheezing or frequent respiratory infections

It’s challenging to make a definitive diagnosis of GERD in infants. This is because the symptoms, such as excessive crying, back arching, regurgitation, and irritability, can also be seen in infants without GERD.

And Silent GERD is even harder to diagnose in babies. It occurs when stomach contents move up but are swallowed again, so there’s no visible spit-up. Yet the irritation and pain are still present.

A baby who is suspected of having GERD will require your doctor to complete an assessment and physical examination, including:

Feeding and dietary history (length and amount of each feed, type of formula given or milk supply when breastfeeding, time between feeds, allergies)
Pattern of vomiting (at night? how long after meals? digested or undigested?)
Prior medications and dietary interventions trialled
Measures of growth.

If necessary, a pediatric gastroenterologist can also perform an ultrasound, endoscopy, barium study, or pH monitoring for a child experiencing extremely bothersome symptoms.

Signs and Symptoms of GERD in Infants vs. Adults

Adults may have some different symptoms of GERD compared to babies, including tooth erosion, chest pain, chronic cough, asthma, laryngitis, and heartburn.

GERD in adults can also lead to an increased risk Barrett’s Esophagus. Barrett’s Esophagus is inflammation of the esophagus and can lead to esophageal cancer.

Here’s a comparison of GERD symptoms in infants and adults:

Symptom	Infants	Adults
Spit-up or regurgitation	Frequent or forceful spit-up after feeds*	Acid reflux or sour taste in the mouth
Discomfort with eating	Irritability, arching back, crying	Heartburn or burning in the chest
Eating behavior	Refusal to feed, frequent pulling off the breast or bottle	Overeating or avoiding trigger foods
Sleep disturbances	Waking frequently, crying when lying flat	Trouble sleeping when lying down, due to reflux
Respiratory symptoms	Coughing, gagging, wheezing	Chronic cough, throat clearing, hoarseness
Silent GERD	No spit-up, but signs of discomfort	Less common, but still possible

*Silent GERD in infants can be tricky to diagnose. Babies may not spit up at all, but still exhibit other symptoms.

GERD in Breastfed Babies

Breast milk is easier for your baby to digest than formula, so breastfed babies may experience fewer reflux episodes. However, GERD can still occur in breastfed babies.

Breastfed babies with GERD might:

Spit up after every feed
Have frequent hiccups, swallow excessively or make gulping noises while breastfeeding
Become fussy or irritable while feeding
Pull off the breast frequently or refuse to latch
Have symptoms worsen when the mother consumes dairy or caffeine

In some cases, removing certain foods from the mother’s diet (such as dairy products) may help to ease the baby’s symptoms. But if you’re considering an elimination diet, consult a dietitian for guidance first, to ensure you’re still getting adequate nutrition.

When to Seek Help

Some spit-up is normal. However, if your baby also shows signs of discomfort or isn’t gaining weight, consult your healthcare provider.

Here are some other red flags that indicate you should talk to your baby’s doctor, as they may have another, more serious condition:

Frequent projectile vomiting
Green or yellow vomit, or blood in the vomit
Onset of vomiting after 6 months or continuation after 1 year

Early support can make a significant difference for both the baby and the parent. The good news is that GERD typically resolves by one year of age in most affected babies.

Managing GERD in Infants

Many cases of GERD in infants improve with time and small changes.

Tips for managing GERD at home:

Keep your baby upright for 20–30 minutes after feedings
Feed smaller amounts more frequently
Burp your baby during and after feeds

A trial of acid-reducing medication
A specialized formula or thickened formula for formula-fed babies, or an elimination diet for breastfeeding parents
Referral to a pediatric gastroenterologist.

The goal is to help your baby feel better with the least intervention.

FAQs About GERD in Infants

How long does GERD last in infants?

GERD usually improves with age, as babies grow and start to eat solids, sit up for more extended periods, and develop stronger abdominal muscles.

Studies show that approximately 25% of 1-month-old infants have GERD, but by three months of age, this rate decreases to under 8%, and by 1 year of age, it is under 2%. Therefore, GER typically resolves in most infants by one year of age.

However, some babies may require ongoing support beyond that, especially if their symptoms are severe.