June 19, 2024

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Symptoms and Best Formula for Reflux

6 min read

If your baby is spitting up frequently after feeding, you can seek advice from your pediatrician about the best formula for infant reflux. There are several designed specifically for this.

But before switching, be sure that you need to change. In some cases, switching may be necessary if your child has signs of gastroesophageal reflux disease (GERD), such as weight loss and chronic coughing.

But if there is no weight loss or other adverse symptoms, switching may not only be unnecessary but may lead to diarrhea and constipation as your baby adjusts to the new formula.

This article will help you decide when infant reflux is harmless or a sign of something serious. It also explains how to choose a new formula and what other options you have for treating reflux in your baby.

Tetra Images / Brand X Pictures / Getty Images 

Is It Normal for Infants to Spit Up?

Infant reflux, or the backflow of food from the stomach to the esophagus (feeding tube), is a perfectly normal situation that can affect formula-fed and breast-fed babies. Studies suggest that 50% of infants under 3 months spit up at least once daily after feeding.

If your baby has reflux but is gaining weight and doesn’t have any other symptoms, you probably don’t need to ​change their formula. Experts often refer to these kids as “happy spitters” as the reflux is usually caused by things like overfeeding or swallowing air while feeding. (Also, keep in mind that the amount a baby spits up often looks like more than it actually is.)

Spitting up may be a problem if the child has signs of gastroesophageal reflux disease or GERD. This occurs when acid reflux is persistent (chronic), causing heartburn and damage to the stomach and esophagus over time.

Other babies spit up due to formula intolerance. This happens when the lack of certain enzymes makes it hard to digest certain ingredients in infant formula. Lactose intolerance is one such example in which exposure to lactose causes bloating, diarrhea, gas, nausea, and regurgitation.

Others still have milk allergies, one of the more common food allergies in infants and babies. This can lead to stomach upset, diarrhea, cramping, and regurgitation.

Acid Reflux Symptoms

Signs of GERD in infants and babies include:

  • Poor feeding
  • Chronic coughing
  • Refusing to eat
  • Weight loss or an inability to gain weight
  • Frequent crying, fussiness, or irritability
  • Frequent choking, wheezing, or difficulty breathing
  • Difficulty swallowing
  • Arching the back during or after feedings

If a child is spitting up and has any of the symptoms noted above, take them to a pediatrician for a diagnosis and treatment.

Changing Formula for Reflux

Unless your baby has other symptoms of a formula intolerance—like a lot of gas, diarrhea, or bloody stools in addition to vomiting or spitting up and being fussy—then changing formula isn’t usually helpful.

If you’re going to try a different formula, then a hypoallergenic formula may be the best choice. Some studies have shown less vomiting in babies who changed to this type of formula.

GERD-specific formulas (sometimes marked with “AR” for acid reflux) can be helpful for babies with reflux. They may be an option if your child doesn’t have a milk protein allergy or lactose intolerance.

Is It Better to Breastfeed?

Infant reflux affects about as many formula-fed babies as breastfed babies. However, formula-fed babies tend to have more frequent and long-lasting episodes, according to research published in the journal Children.

Best Formula for Reflux

The best formula for infant reflux is the one that works for your baby. This can differ from one child to the next based on the underlying cause of reflux.

Popular options include:

  • Similac Alimentum: A hypoallergenic formula made mainly from corn that is designed for children with food allergies, colic, and lactose intolerance
  • Nutramigen: Another hypoallergenic formula boosted with probiotics that was designed for children with milk allergies and lactose intolerance
  • Enfamil AR: An infant formula made from milk powder and thickeners that create a creamier texture which helps ease acid reflux symptoms
  • Similac for Spit-Up: An infant formula made from milk protein and a rice starch thickener that is also suitable for babies with acid reflux
  • Gerber Good Start Extensive HA: An infant formula made from soy powder that is safe for children with milk allergies and lactose intolerance

Diagnosing Reflux

Healthcare providers generally diagnose reflux based on the characteristic symptoms.

If they suspect your baby has an obstruction or something else causing the vomiting, they may order X-rays called an upper gastrointestinal (GI) series. Another possible test is a pH probe, but it’s an invasive test and isn’t done often.

If your baby has persistent symptoms, especially with low weight gain, you may be sent to a pediatric gastroenterologist. In rare and serious cases, a surgical procedure may be an option.

Treating Reflux

For babies with reflux and GERD, treatments can include lifestyle changes and reflux medications.

Lifestyle changes include:

  • Thickening formula with rice cereal (you may have to enlarge the hole of the nipple)
  • Positioning changes such as keeping them upright for at least 30 minutes after eating
  • Feeding smaller amounts more frequently instead of larger, less frequent feedings

Reflux medications include acid reducers such as:

  • Nexium (esomeprazole)
  • Prevacid (lansoprazole)
  • Pepcid/Zantac (famotidine)

Your baby may not need reflux medication if they:

  • Are happy spitters
  • Have good weight gain
  • Don’t cry excessively
  • Don’t have feeding or respiratory problems

In 2020, the Food and Drug Administration (FDA) announced the recall of all medications containing ranitidine, formerly known by the brand name Zantac. The FDA said to stop taking ranitidine and to talk to your healthcare provider about alternatives. Since then, Zantac has come back onto the market as Zantac 360, with a different active ingredient, the histamine blocker famotidine.


If your baby spits up a lot, they may have acid reflux or GERD. If they’re gaining weight normally and don’t have other symptoms, it may not be a problem.

If they’re not gaining weight, are irritable, or have other GERD symptoms, they may need to be treated. Changing formulas can sometimes help, especially if you go to a hypoallergenic product or a formula designed for babies with reflux.

GERD is often diagnosed based on symptoms alone. Other tests may help rule out other causes of symptoms. Treatment includes simple changes to your feeding routine (such as positioning changes or feeding smaller amounts) and acid-reducing medications.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. MedlinePlus. Reflux in infants.

  3. National Institutes of Health. Lactose intolerance.

  4. American College of Allergy, Asthma, and Immunology. Milk and dairy.

  5. Rosen R, Vandenplas Y, Singendonk M, et al. Pediatric gastroesophageal reflux clinical practice guidelines: Joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr. 2018;66(3):516-554. doi:10.1097/MPG.0000000000001889

  6. Ramirez-Farias C, Baggs GE, Marriage BJ. Growth, tolerance, and compliance of infants fed an extensively hydrolyzed infant formula with added 2′-FL fucosyllactose (2′-FL) human milk oligosaccharide. Nutrients. 2021;13(1):186. doi:10.3390/nu13010186

  7. Pados BF, Feaster V. Effect of formula type and preparation on international dysphagia diet standardisation initiative thickness level and milk flow rates from bottle teats. Am J Speech Lang Pathol. 2021;30(1):260-265. doi:10.1044/2020_ajslp-20-00272

  8. Yourkavitch J, Zadrozny S, Flax VL. Reflux incidence among exclusively breast milk red infants: differences of feeding at breast versus pumped milk. Children (Basel). 2016 Dec;3(4):18. doi:10.3390/children3040018

  9. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. Diagnosis of GER & GERD in infants.

  10. Yoo BG, Yang HK, Lee YJ, Byun SY, Kim HY, Park JH. Fundoplication in neonates and infants with primary gastroesophageal reflux. Pediatric Gastroenterology, Hepatology & Nutrition. 2014;17(2):93-97. doi:10.5223/pghn.2014.17.2.93

  11. Food and Drug Administration. FDA Requests Removal of All Ranitidine Products (Zantac) from the Market.

By Vincent Iannelli, MD

 Vincent Iannelli, MD, is a board-certified pediatrician and fellow of the American Academy of Pediatrics. Dr. Iannelli has cared for children for more than 20 years. 


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