What is gastro-oesophageal reflux disease (GORD)?

Gastro-oesophageal reflux disease (GORD) is when your baby develops issues from ongoing reflux.

GORD happens when acid from your baby’s stomach burns and damages their oesophagus (food pipe).

This is painful for your baby and can cause other complications.

Gastro-oesophageal reflux (GOR) is when your baby vomits after feeding. This is often called ‘spitting up’ and is normal in healthy babies.

It often begins when they are about 2 months old. Most babies will stop having reflux by the time they are 18 months old unless they have other health conditions that affect their muscles such as cerebral palsy.

What are the symptoms of GORD?

GORD is when reflux occurs with other symptoms such as:

• refusing to feed
• irritable or unsettled after feeding
• slow weight gain
• choking, gagging or coughing during feeding
• vomiting blood (haematemesis)

CHECK YOUR SYMPTOMS — Use the Symptom Checker and find out if you need to seek medical help.

What causes GORD?

In babies, the valve at the top of the stomach is looser than in adults. This means the contents of your baby’s stomach can travel back up their oesophagus (food pipe) more easily.

As your baby gets older, this valve becomes stronger, and the reflux will usually stop.

When should I see my doctor?

See your doctor if you’ve tried to ease your babies reflux, but it hasn’t worked. You should also see your doctor, if your baby:

• has slow weight gain or a sudden weight loss
• first gets reflux after 6 months of age
• is older than 1 year and still has reflux

If you are worried about your baby, take them to get checked by your doctor.

When to seek urgent care

You should see your doctor as soon as possible if your baby has any of these symptoms:

• vomiting blood (known as haematemesis)
• large amounts of vomiting
• trouble swallowing
• swollen or sore stomach
• refusing food or milk
• fever — a temperature of 38°C or higher

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How is GORD diagnosed?

Your doctor will examine your baby and ask you about their symptoms. They will check your baby’s growth and development.

They may ask to watch your baby feed to help find the cause of the reflux.

Your doctor may also refer your baby for more tests, such as an endoscopy or x-ray, but this is rare.

They may refer you to a paediatrician (children’s doctor) for more advice.

How is GORD treated?

There are many ways to manage GORD, depending on your baby’s symptoms.

Self-care at home

Holding your baby in a more upright position for 20–30 minutes after feeding can help reduce reflux.

Play

It’s also important to avoid movements like bouncing or playing after feeding your baby. This gives your baby time to digest their food.

Sleep

Always follow safe sleeping guidelines and place your baby flat on their back to sleep. Placing your baby on their tummy to sleep is not safe and this will not help with reflux.

Feeding your baby

Continue to feed in the way you have chosen (breast or bottle feed) even if your baby has GORD. Changing how you feed your baby will not improve their reflux.

You should not change from breastfeeding or change the formula unless advised by your doctor or healthcare professional.

Smaller feeds

Feeding your baby in regular small amounts can help stop reflux. This is not right for all babies.

An experienced child health nurse can examine your baby and watch them feed to decide if smaller amounts will help.

Thicker feeds

For bottle fed babies, thicker feeds may reduce vomiting. Thickener can be used in formula and breast milk and can be given as a gel during breastfeeding.

Some pre-thickened formulas can cause constipation. Don’t thicken your baby’s feeds without first getting advice from your doctor.

Cow milk allergy

About 4 in 10 babies with GORD have cow milk protein allergy (CMPA). If your doctor thinks your baby might have CMPA, they will suggest that you remove cow milk from your child’s diet for 2 weeks.

Breastfeeding mothers should also avoid dairy products during this time. Your doctor will tell you if this is right for you and your baby.

Medicines for GORD in babies

Your doctor may recommend medicine. These medicines can help reduce the acid in your baby’s stomach or can treat infections.

Some medicines are not suitable for babies and can cause harm. Always follow your doctor’s instruction before giving your baby medicine.

Living with GORD

GORD can be stressful for parents and babies as it changes your baby’s normal feeding, sleeping and crying patterns.

If you or your baby are struggling with GORD speak to your local child health nurse or doctor for advice.

What are the complications of GORD?

GORD often causes complications like slow weight gain and irritability during feeding. In older children it may cause chest pain or tummy pain after meals.

It can also cause oesophagitis (inflammation of the oesophagus) or breathing changes, but this is rare.

If it is well managed, GORD is unlikely to cause problems later in life.

Can GORD be prevented?

You can take steps to lower your baby's chance of having GORD.

Avoid smoking

Smoke in the air can contribute to your baby having reflux. It’s important that you and other people don’t smoke or vape around your baby.

Learn more about the effects of passive smoking and vaping.

Follow feeding guidelines

It’s important to follow feeding guidelines. The guidelines suggest you should introduce solid food at around 6 months of age. Starting solid food earlier does not help with reflux.

When your baby is ready to start solids, introduce a mix of foods. It’s best to start with soft foods that are high in iron, while continuing to breastfeed or formula feed.

Resources and support

If you have any questions or concerns about GORD, speak to your doctor or child health nurse.

Find out more about the treatment of GORD in babies and children at the Royal Children’s Hospital Melbourne website.