Reflux 101 – When Baby Cries Too Much

March 1, 2011 |  by  |  featured, fussy baby, Medical Wrinkles

So your baby cries. What baby doesn’t? What, he spits up a lot too? Welcome to life with babies. Crying and spitup is not a problem. Unless it is.

Happy Spitters

Babies spit up. Some even spit up with such force that it flies across the room. They may spitup so much that it can feel like each feeding is an effort in futility. Big spitters will mark every piece of furniture you own, every carpet, ever piece of clothing with baby vomit. Sometimes they will choke and cough on their own vomit so much that you keep the phone ready with your fingers on 9-1-1. Even the term, spitup, seems too petite and cute for what your baby does. Your baby VOMITS. Often and with great gusto.

Is this OK? Probably.

  • Is your baby gaining weight?
  • Is he happy?

If your baby is reasonably happy and growing at a pace that keeps your pediatrician happy, then regardless of how much the spitup bothers YOU, it’s not a problem. The choking, the projectile vomit, soaking his clothes after every feeding, etc. is not a medical concern. Buy some carpet cleaner. Do lots of laundry. And relax. Your baby is fine.

But how do you know if your baby is happy? Newborn babies cry. A lot.

The average newborn cries for a total of 3 hours throughout the day. Crying and/or fussiness peaks at 6-weeks of age. Typically crying drops to about 1 hour a day by 3 months.

It is almost impossible to really measure how much your newborn baby cries throughout the day. For starters, you’re probably too busy trying to soothe him to really keep track. Secondly, when they do cry it seems like an eternity. Parents are notoriously bad at actually knowing how much their babies cry because 15 minutes can seem like hours.

But lets assume that your baby cries a lot. Maybe more than average. Enough that you’re starting to have concerns that he may have some contributing medical factor like reflux or colic (this post won’t get into colic but it will be covered in the future – use the subscription options on the right if you want to get updates on future postings). Maybe your baby cries a lot and NEVER spits up.

But the bottom line is that you have a really unhappy baby and you’re starting to wonder why he’s so unhappy.

Reflux Defined:

We all have a valve at the top of the stomach that lets food go IN but keeps food from coming back OUT. In most newborns this valve is not fully developed and stomach contents are pushed back up the esophagus and come out of the baby’s mouth. This is called spitup or baby vomit. Over time, this valve matures and the stomach contents stay IN the stomach.

For some babies, having stomach contents pushed up into the esophagus can cause irritation which is just like an adult who suffers from heartburn. So the problem is not the spitup, the problem is discomfort. Most babies will spitup. Only a small number of babies will suffer from reflux related discomfort.

Some babies will have discomfort without visible spitup. These babies are called “silent refluxers.” The stomach acid is being pushed up into their esophagus, causing discomfort, but without enough force to make it all the way up to come out as spitup.

So again, spitup by itself is nothing to worry about.

How Do You Know if Your Baby Has Reflux?

Ultimately this is a determination that you and your pediatrician will need to make together. Unfortunately there aren’t any non-invasive medical tests to make a diagnosis so generally you observe your baby, make an educated guess, and discuss lifestyle & drug treatments with your Dr. If your baby has more than a few symptoms listed below, its time to make an appointment:

  • Cries a LOT (substantially over 3 hours a day)
  • May cry excessively after feedings or while/after spitting up
  • Is irritable/fussy/crying due to PAIN
  • Seems to cry even more when placed on back or in a car seat
  • Has frequent hiccups
  • Coughs often
  • Seems hungry but then refuses breast/bottle after eating very little (but then may want to eat 2 minutes later just to repeat the same process)
  • Has chronic ear infections
  • Sleeps poorly, especially during the day (although it’s not uncommon for refluxing babies to sleep well at night out of sheer exhaustion)
  • Chronic wheezing
  • Arching back after feeding
  • Your parenting instinct tells you your baby’s tummy hurts

Other factors to consider when considering the possibility of infant reflux:

  • Many babies with reflux don’t show any symptoms until they are 3 months old. Presumably this is because it takes time for the stomach acid to result in significant discomfort.
  • Reflux is hereditary. If you, your partner, or immediate family members suffer from heartburn, your baby is at greater risk.
  • Reflux is more common in premature babies.

Reflux can be a frustrating and difficult problem to diagnose. According to Dr. Harvy Karp over 25% of all babies in the US are treated for reflux when less than 2% actually have it.¬† As a culture we are running to medicate babies who are simply fussy, crying, and spitting up BECAUSE they are babies. You need to listen to your heart. Trust your gut. Talk to your pediatrician. And work with lifestyle remedies (discussed further in a future post). If things don’t improve, it may be time to look into medications or possibly an evaluation with a pediatric GI specialist.

Further reading on Infant Reflux:

Crying Over Spilt Milk – Another highly credible site on reflux, symptoms, treatment, etc. however this one comes out of New Zealand. Use the menu on the left for helpful information on symptoms, diagnosis, and treatment. Some of the vernacular is going to be unusual to Americans (“happy chucker” = baby who spits up a lot but doesn’t seem uncomfortable).

Infant Reflux Disease – Good site with general reflux information and a parent forum. Parent forums can be really helpful resources if you can put in the time to wade through them. Especially if you are looking for lifestyle management solutions for reflux (read: non-medical solutions to keep your unhappy spitter happy).

Reflux Rebels – A good source of information and a good parent forum. I particularly like this article on common infant reflux myths.

Infant Reflux – Another good forum (although most of the site content outside of the forum is out of date or contains broken links).
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  1. Pretty good article. My husband and I both have acid reflux and our two older children were on medication for it as babies. I’m pretty sure baby #3 (now 6 weeks) may need it too.

    Child #1 projectile vomited over 3 times a day. She went through 5 outfits a day most of the time. She also chocked constantly, even turning blue once, and she needed baby heimlich. Very scary. She was pretty happy though. She only cried when it hurt, not for long periods. But she still needed medication because of the choking. She had an upper GI to diagnose it and she refluxed on camera. Many times we had to pull the car over and rush to get her out of her carseat and do back blows.

    Child #2 wasn’t quite as bad but was more cranky. She still needed medications. Had same test (Upper GI). I don’t remember as much about her symptoms.

    You are right about it peaking at 3 months. That’s when both children had their test.

  2. Wow.
    It must have been impossible to get out of the house if every car trip was a potential medical catastrophe. Yike!

    Just curious – what medication helped with the choking? I’m most familiar with Zantac and Prevacid which reduce acidity but not volume (so the choking would continue albeit less painfully).

  3. Very helpful article!

    Just wanted to add that many times doctors diagnose reflux while its food allergies.

    I know of many cases, myself included, where the doctor’s diagnosis was reflux, but the lactation consultant’s advice to eliminate cow protein from the moms diet (milk, cheese, butter etc) worked like a charm… making the “reflux” disappear.

  4. We found out our 6 month old son had “silent reflux” when we kept taking him to the doctor because he sounded super congested and it just wasn’t getting better. The doctor checked his lungs each time and they were clear, but he still sounded horrible–not just coughing, but his breathing sounded horrible too. Finally they suggested it might be silent reflux and gave us zantac. It’s seemed to help, but he still sounds super congested. The doctor doesn’t seem worried, but his breathing just sounds so bad, like he’s been smoking for decades…could it be something else?

    • Hey Emmi,
      Zantac won’t keep his food from coming up into this throat. And THAT is why he sounds congested – the food coming up. Nothing will stop this from happening. Well TIME will but you can’t force it.

      Zantac will reduce the acidity of his stomach contents so if your baby is unhappy, this should help alleviate what is effectively baby heart burn. But if your baby is NOT unhappy, seems perfectly content, but is really congested or what not, Zantac won’t fix that.

      Sorry :(

      • Thanks Alexis!
        He doesn’t seem unhappy anymore (he was super fussy before the zantac and when we stopped it for a bit), it just worries me to hear him sound like that because it sounds so icky. Thank you for letting me know it’s normal!

    • Emmi I can totally sympathize. Have you tried putting your baby to sleep in his side? It made such a difference with our daughter. If we put her on her back she would arch her back, gasping for air, and I know she wasn’t getting any sleep. Putting her on her side was actually something our Ped suggested. For the first three months we had her swaddled, on her side, with rolled up blankets to keep her supported. I would definitely ask your Ped if that is something you can do, just to give you a peace of mind when putting him to sleep.

  5. My 2 month old son has reflux. Our naturopath and pediatrician recommended a dairy and gluten free diet. My question is, how come this food “allergy” didn’t begin or bother my baby until he is two months old? Help!

    • There is a huge connection between reflux and milk issues. Chances are it’s bothered him all along HOWEVER it takes time for the irritation in the esophagus to build up to the point that you can see the effects (in terms of behavior, sleep, etc.).

      Studies show that 50% of kids with reflux will see symptoms abate if Mom goes off dairy, so I highly recommend you try. Gluten is a whole different issue but there is no harm in giving it a try.

      Note: I’ve got a HUGE and AMAZING post on food allergies and babies coming out next week. A reader put it together and it’s frankly, a fantastic resource. So you should come back and check it out next week :)

      • Thank you so much for your reply! I stopped eating both dairy and gluten 5 days ago. I may have noticed a slight improvement but he is definitely still spitting up and he cries from 30 minutes to an hour almost every night.
        How long does it take for the muscle to rebuild and for the reflux to go away?
        Our naturopath recommended probiotics so I am giving that to him as well.
        This is a great forum, I will definitely read your next article and everything else you publish.
        Thank you again, much appreciated.

  6. Hi
    I read so many articles about silent reflux and I am really confused!
    I would really appreciate it if you could let me know what you think.
    My baby had reflux which started when she was 1 month old – she vomited almost after every feeding. I must note that baby did not cry a lot, she slept well and was I would say a happy baby BUT she vomited. First question: why reflux started when she was 1 month old and not earlier? She never vomited in the first 4 weeks.
    Since then we tried 5 different formulas (AR formulas, thickened to keep milk in the stomach). Some of them caused diarrhea, other pain and colics and others just did not help. They all made her miserable and crying all the time. Until we tried the 5th formula. Suddenly NO VOMITING. Also NO COLICS.
    But we suddenly started noticing some symptoms of silent reflux. Second question: Can an AR formula turn reflux into silent reflux?? I.e. No visible vomiting but baby still has reflux? Please let me know what you think.
    The signs we noticed is:
    1. Crying after feeding (for around 30 minutes until she finally sleeps in our arms)
    2. Fussy when sleeping and sometimes crying (but I read this could be normal for babies)
    3. Increased saliva (but I read this could be normal now that she is 2 months old)
    4. Hiccups (once a day is frequent?)
    5. Sometimes she swallows hours after eating (maybe she just swallows her saliva?)


  7. Apologies, I forgot one last question.
    Third question: is silent reflux without much crying possible? baby cries only after feeding and of course when hungry before feeding. Or babies with silent reflux always cry a lot?
    Thanks again

  8. Thanks for all of your information.

    My daughter is 13 months old and has CMPI (on neocate) and silent reflux for which she takes Prevacid. We are currently trying to strike a good balance between a dosage that controls her reflux but dosen’t cause excessive wind (which almost causes her as much grief). Have you heard of this before? For now, my GI thinks changing PPI’s wouldn’t make a difference??

    Secondly, she sleeps in a stationary pram / swing and still has significant cough/ splutter episodes. In good patches she can self settle after these. They are are worse during colds, teeth and when she has more wind. I thought this might have improved by now and we could get her into a cot. Would your educated guess be that this is likely to happen anytime soon?? Now that we have passed the “12 month milestone” is there another time frame to look towards or is this a sign that we still have a long road to travel??

    Thanks for your thoughts.

    P.S I’m writing this in the middle of the night so apologies if it doesn’t make sense.

  9. Thank you so much. My granddaughter appears to be a silent refluxer. She is miserable on her back and fusses like she is in apparent pain when laid back…can’t get her to sleep past an hour at a time unless she is on her stomach. I have been so consumed with keeping her on her back and didn’t think on side was still an option today…this will likely get us some relief until we can get her doctor to confirm the reflux. Thank you so much.

  10. Thanks for this info… My son Liam started to become fussy AFTER 7 weeks which from what I am reading on your site is around should when the fussiness peaks and then starts to level or drop off. Well, he wasn’t fussy prior to 6 weeks really at all so i am now wondering if it is a Dairy sensitivity that is just now showing up as it has taken this amount of time to get to the point of irritating his esophagus like you said , Anyway… does this make sense? I think I’ll try giving up dairy for a while and see if he fusses less as fussiness was not his norm at all before around 7 weeks of age. Any feedback is appreciated!!

    • It IS a possibility but I’m not sure I would rush out to eliminate milk proteins just yet. As many as 25% of parents convince themselves that they have a milk issue when (studies are mixed on this) anywhere between 5-10% actually do. Why? Because babies are mysterious, they get fussy, you go off dairy, things get better so you assume, “Well I guess that was it!” When maybe it was a fluke. Or the 6 week sleep regression. Or because he’s not getting enough sleep. Or because it’s a Tuesday.

      I would definitely talk about your concerns with your pediatrician, and possibly consider going dairy free. But I would also encourage you to give things time to ensure it’s not just a blip? Good luck!

      • Thanks! He does seem to be a lot less fussy when I am able to “Houdini soothe him” down for regular naps. So that is one conrtibuting factor. It’s also so helpful to know that fssing some of the time is normal.

  11. My 5.5 week premature daughter was diagnosed with reflux at 7 weeks. She started on Zantac then, which seemed to be only occasionally effective. It seems that as she develops – sitting, starting solids, crawling – her reflux worsens, then stabilizes a bit.
    At 5 months we started CIO on the advice of our pediatrician. We stuck to the book even though it became incredibly emotionally hard to listen to her cry after 3, 4, 7 weeks of inconsistent results. Sometimes she falls asleep without a peep; most nights, she cries as soon as we carry her near the crib to be put down and doesn’t stop for up to 45 minutes.
    Daytime naps are only achieved through a feeding and being held. We have been unable to nap train her at all, and her night time sleep ritual is starting to mirror the day. She is only comforted by a small bottle, and if she is put down or even moved near her crib, she begins to cry hysterically.

    I understand te theory behind CIO – I drank the Kool-Aid, we tried it and want it to work desperately. But my worry is that with her developmental changes and worsening reflux that the CIO may actually be causing her to reflux more when she bawls, causing her real physical pain, thus extending the cycle of crying. We have an appointment with a pediatric GI, but not for a few weeks, and with her sleep recently worsening even more (20 min daytime naps, crying and misery in the meantime), I wonder if you have any thoughts or suggestions. Thanks for offering a small piece of sanity in an otherwise insane and frightening Internet world.

    • Dear Sad Mommy,

      Based on what you’re saying it sounds like CIO might not be the right call for your daughter, at least not at this moment.

      Reflux is tricky and super common with preemies (25% of preemies have reflux). Zantac is a relatively mild drug and while, a great place to start, may not be enough. You mention she only takes a small bottle and reflux kids often take small feeds because big feeds hurt their tummy. It’s great to see a GI specialist but there isn’t much they can to without an endoscopy and a firm diagnosis will likely lead you to Prevacid so one option would be just to do a trial of Prevacid now.

      Also given that your child is preemie (not sure if that’s 5 months based on birth age or adjusted age) AND has reflux, you might want to give up on the crib entirely and talk to your pediatrician about swing sleep. Swing, swaddle, white noise. Also (challenging) try to schedule feedings so that she isn’t eating just prior to sleeping because food+lying down = bad times. Swings keep kiddos upright and the motion is soothing so it may be helpful if your pediatrician is OK with sleep in there. Her frequent night waking could be related to reflux and have nothing to do with falling asleep independently (or not) so CIO is likely a mismatch based on what you’re dealing with.

      I know none of this fixes anything but I hope it gives you some new directions to pursue and helps you feel slightly less sad! If it helps at all I’ve totally been where you’re at and it’s TERRIBLE. But also, not forever. I promise you that one day, you will look back on this and think, “Thank GOD that’s behind us!”

      • Thanks for the reply – I really appreciate your feedback. Unfortunately, we’ve tried a lot of those suggestions, and nothing seems to be helping. DD hated the swings, broke swaddles at 5 weeks, and you name it, we’ve probably tried it (hence me resorting to posting a comment here – sorry for not giving a more complete picture in the original post. I was sleep deprived, phone-typing with a fidgety baby sleeping on me). She is 8 months birth, almost 7 adjusted now. Ped prescribed Prevacid but it seemed to make her reflux worse, surprisingly. Much more back-arching, refusing feedings, increased night wakings, etc. That’s why the ped suggested a GI consult.
        Our ped practice is VERY CIO-positive (the president of the practice is a nationally-renown CIO sleep specialist), and we probably wouldn’t have started CIO so early without their encouragement. After 2 months of “training”, I continued to voice my concerns to them, but was encouraged to stick with it as to not ruin the weeks of training we had already subjected the entire family to. Guess this all goes back to knowing your baby and trusting your gut.

        • Not sure why Prevacid was an issue but some kids have a hard time with it. You didn’t just swap Zantac for Prevacid did you? Prevacid takes 3-5 days to build up so ideally you stick with Zantac and add Prevacid on. Also must be taken with food. Maybe try a different PPI medication?

          Also I don’t believe in ruining weeks of training IF there’s an underlying problem that’s not fully addressed. Tummy issues muck up everything so if that’s a strong consideration, step #1 is deal with the tummy stuff.

          Soo frustrating. Our little guy used to be inconsolable for 2-3 hours every night so we would drive around from 2-5 AM because that was the only thing that helped. See? Tummy issues blow :(

          Good luck!

          • Hi Alexis,
            I also have a preemie with reflux/spitting up issues. My little guy was born at 26.6 weeks and is now almost 8mos old/ 5mos adjusted. Despite his prematurity, he left the hospital with no long-term medical issues (thus far) and in the eyes of his medical team, he is doing fantastically well. However, he has been waking up every hour for the past few weeks and my husband and I are looking to initiate CIO. I have so many questions!! Much to my horror, our LO was a tummy sleeper from the moment we brought him home-we could not get him to fall asleep on his back despite our valiant and exhausting efforts (we told our docs and they supported our decision to keep him on his side and watch him like hawks). So 4mos adjusted age rolls around and now so does our little guy. He rolls. From belly to back with fantastic skill. And of course, as soon as he finds himself on his back-he lets us know about it. So now he is rolling over every hour or so past the midnight mark and we are getting pretty exhausted. Having a preemie is a longer newborn slog than it is for most parents, and after our sleepless two months in the hospital we had an extra month of newborn at home. He is also a champion spit-upper. We let this go on for a while without meds until he started crying. My Mama gut told me it was reflux pain and we put him on Zantac. He has not had any pain crying since then and is a generally happy (albeit messy) spitter-upper guy. So here we are. We would like to get some sleep for him and for us. We think it might be time for CIO. But here are my questions: 1) Do we go by actual age or adjusted age to determine readiness for CIO? He’s a clever guy who has even started mimicking some basic sounds-a 7mos skill; but on other things he is clearly still 5mos. 2) The spit up can cause choking. Sometimes it is a bit alarming and in one instance when he flipped onto his back and started crying hard-he also choked hard (not enough to stop breathing) but believe me I could not have gotten into that room fast enough to satisfy my Mama lion. The follow up question is: how do we sleep train and deal with the inevitable spit-up and the possible choking? Help! Help!
            -Worried Mama Lisa

  12. How do you know if your baby has only mild reflux


  1. Helping Your Baby Welcome Baby #2: Sibling Transition | Troublesome Tots
  2. The Ultimate Baby Swing Sleep Guide For Swing Hating Babies | Troublesome Tots
  3. 5 Reasons Your Baby Hates the Crib | Troublesome Tots
  4. What to Do About Infant Reflux?

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