Signs & Symptoms
The list below gives a general overview of some of the signs and symptoms of infant reflux that may be displayed. A child with reflux will not necessarily display all of them, and the number of signs exhibited does not indicate the severity of their reflux.
There are other signs your child may display as well. If you suspect your child may have reflux (either gastro-oesophageal reflux or gastro-oesophageal reflux disease) or have any questions or concerns, it is important to discuss them with your child’s doctor or child health nurse.
Reflux is not the only cause of these signs, and there can be other reasons for their issues or behaviour. Healthy infants can also reflux at times. Children with reflux do not necessarily vomit – this is commonly called silent reflux.
Gastro-oesophageal reflux is a normal physiological event – it is termed gastro-oesophageal reflux disease when it results in harm. However, signs and symptoms do not always correlate with the severity of reflux, and it can be difficult for a doctor to determine whether a child has Gastro-Oesophageal Reflux (GOR – the condition) or Gastro-Oesophageal Reflux Disease (GORD). Therefore, the following list makes no distinction about whether signs may be related to GOR or GORD.
Symptoms in Infants and Children under the age of 2 years
- Irritability, excessive crying or screaming.
- Vomiting, posseting or regurgitation.
- Appearing to be in pain.
- Recurrent hiccups.
- ‘Wet’ burp or hiccups.
- Congestion, ‘snuffling’ or appearing to have a cold.
- Bad or sour-smelling breath.
- Feeding issues:
- Displaying a fear of food or unwillingness to eat.
- Pulling away and arching their back.
- Crying during or after feeds.
- Refusal to feed or only take a small amount despite being hungry.
- Comfort feeding – wanting to feed or suck frequently.
- Sleeping issues:
- Catnapping during the day.
- Difficulty settling.
- Frequent night waking (though some refluxers do sleep well at night).
- Restless or easily disturbed sleep.
- Gulping, gagging, or spluttering.
- Difficulty swallowing.
- Respiratory problems – for example, choking, coughing, wheezing or frequent chest infections.
- Weight issues – for example, inadequate weight gain, weight loss or excessive weight gain.
- Frequent red, sore throat, with infection, not necessarily a factor.
- Recurrent ear, throat or sinus infections or croup.
- Drooling or excessive salivation
- Dental erosion/decay.
- Gagging themselves (using their hand/fist/fingers).
Gastro-oesophageal reflux commonly presents with regurgitating or posseting; however, there are many other signs that infants and children can display. Some babies have reflux without it coming out of their mouths (termed silent reflux, although the term ‘silent reflux’ can be confusing because silence is generally not one of the signs they exhibit).
Symptoms in Older Children
Signs and symptoms can change as children get older. While older children/teenagers may have some of the previously listed signs and symptoms, they may also suffer from issues such as:
- Nausea, vomiting or indigestion.
- Heartburn, pain or discomfort in their chest or abdomen.
- Feeling of a lump in their throat, frequent throat clearing.
- Bitter or sour taste in their mouth.
- Difficulty swallowing.
- Chronic red, sore throat.
- Sleeping issues – for example, insomnia and night waking.
- Eating issues – for example, low appetite, fussy eating or constant grazing.
- Respiratory issues – for example, wheezing, coughing and chest infections.
- ENT (ear, nose and throat) issues – for example, sinus infections or hoarseness.
- Behavioural issues.
This article is written for the benefit of reflux parents, based on the experiences of reflux parents. It is not meant to replace medical advice and is of a general nature only. If you have any questions or concerns, please seek advice from your medical professional.
Written by Glenda Blanch, RISA Inc member and author of Reflux Reality: A Guide for Families in association with RISA Inc © 2010.
Additional information on gastro-oesophageal reflux is provided in our book Reflux Reality: A Guide for Families.
Information reviewed by:
Dr Anthony Catto-Smith
Director, Department of Gastroenterology and Clinical Nutrition
Royal Children’s Hospital
Melbourne, Victoria Australia
- Barmby, L. (1998 (edited 2004)). Breastfeeding the Baby with Gastroesophageal Reflux. Retrieved August 8, 2010, from La Leche League International: llli.org/NB/NBNovDec98p175.html
- Boyce, H. W., & Bakheet, M. R. (2005). Sialorrhea – A Review of a Vexing, Often Unrecognised Sign of Oropharyngeal and Esophageal Disease. Journal of Clinical Gastroenterology, 39 (2), 89-97.
- Campanozzi, A., Boccia, G., Pensabene, L., Panetta, F., Strisciuglio, P., Marseglia, A., et al. (2009). Prevalence and Natural History of Gastroesophageal Reflux: Pediatric Prospective Survey. Pediatrics, 123 (3), 779-783.
- CDHNF. (2005). Parent’s Checklist for REFLUX in Infants 0-12 months old. Retrieved August 8, 2010, from Pediatric GERD: gerd.cdhnf.org/User/Docs/pdf/GERD_Checklist.pdf
- CDHNF. (2007, September 24). Pediatric Gastroesophageal Reflux Evaluation and Management. Retrieved April 28, 2008, from Children’s Digestive Health and Nutrition Foundation: gerd.cdhnf.org/User/Docs/PDF/Slides/GERD_Core_Set_1_Hour.pdf
- Cradle 2 Kindy. (2008, April 29). Irritable Baby Syndrome – colic/reflux. Retrieved August 8, 2010, from Cradle 2 Kindy Parenting Solutions: cradle2kindy.com.au/BlogRetrieve.aspx?BlogID=1159&PostID=15358
- Harnsberger, J. K. (2008). Management Algorithm #2: Management of a Child or Adolescent With Chronic Heartburn. Retrieved April 2, 2008, from Medscape Pediatrics: cme.medscape.com/viewarticle/494079_3
- NDDIC. (2006, August). Gastroesophageal Reflux in Children and Adolescents. Retrieved March 28, 2008, from National Digestive Diseases Information Clearinghouse: digestive.niddk.nih.gov/ddiseases/pubs/gerinchildren/index.htm
- Schwarz, S. M., & Hebra, A. (2008, Jan 18). Gastroesophageal Reflux. Retrieved March 24, 2008, from Medicine: emedicine.com/PED/topic1177.htm
- Vandenplas, Y., Lifshitz, J. Z., Orenstein, S., Lifschitz, C. H., Shepherd, R. W., Casaubón, P. R., et al. (1998). Review Article. Nutritional Management of Regurgitation in Infants. Journal of the American College of Nutrition, 17 (4), 308 – 316.
- Vandenplas, Y., Salvatore, S., & Hauser, B. (2005). The diagnosis and management of gastro-oesophageal reflux in infants. Early Human Development, 81 (12), 1011 – 24. Abstract available at earlyhumandevelopment.com/article/S0378-3782%2805%2900202-1/abstract
Reflux Management Tips
Different techniques work for different refluxers so trial and error are needed to identify any that may help you. They may work for refluxers and silent refluxers alike. If you have any concerns, please discuss these with your child’s doctor or Child Health Nurse.
Why ‘Google’ your health questions, when you can ‘Cochrane’ them?
Have you ever been to the doctor and been confronted with a treatment you knew nothing about and an explanation that left you just as confused? How do you decide which treatment is best for you? What are a treatment’s harms, benefits and objectives? If you have ever struggled with any of these questions, please consider visiting the Cochrane Collaboration Library.
RISA information for printing
Here’s the standard RISA brochure that will be distributed to Child Health Care centres and alike to help parents identify whether to seek further help for a child displaying symptoms of gastro-oesophageal reflux disease. Please feel free to download, print and distribute. They are intended for an Australian audience but RISA does accept international membership and often helps international parents via email.