Diagnosis and Management of Gastro-esophageal Reflux in Preterm Infants 

Eric C Eichenwald  

Gastro-oesophageal reflux (GOR) generally defined as the passage of gastric contents into the oesophagus, is an almost universal phenomenon in preterm infants. It is a common diagnosis in the NICU; however, there is large variation in its treatment across NICU sites.  


Many premature babies are diagnosed with Gastro-oesophageal reflux (GOR) either during their NICU stay or after, with otherwise known simply as reflux—which is when the muscular ring at the end of the tube connecting the mouth to the stomach, called the lower oesophageal sphincter (LES), doesn't close properly. This allows stomach contents to flow back into the tube. In premature babies, this can happen more often because they might get large liquid feedings while lying on their back. 

When babies are fed while lying on their back (supine position), gravity can't help pull milk into the stomach. Instead, some milk stays near the junction of the stomach and the tube (gastroesophageal junction). In this spot, the milk is more likely to come back up into the tube if the lower oesophageal sphincter (LES) relaxes. 

Also, premature babies with a shorter and narrower tube may experience more reflux because it can displace the LES, making it easier for stomach contents to move back into the tube. 

Reflux in babies often improves over several months, but there are steps you can take to alleviate your baby's symptoms: 

  • Offer smaller, more frequent feeds for your baby. 
  • Hold your baby upright after feeding, with their chest against yours and legs straight down. 
  • Avoid putting your baby in a car seat or infant seat after feeding, as any position that brings their legs closer to the stomach can increase pressure on the stomach and exacerbate reflux.

In most cases, reflux will not harm your baby, and doesn't require treatment.  

Reflux in babies gets better with time as: 

  • They start to eat solids. 
  • They learn to sit up. 
  • The ring of muscle at the top of their stomach gets stronger. 

If the reflux is causing problems, this could be Gastro-oesophageal reflux disease (GORD), which may need treatment. 

What is Gastro-oesophageal reflux disease (GORD) in babies? 

Gastro-oesophageal reflux disease (GORD) is different to reflux. GORD is a medical condition that needs to be diagnosed by a doctor and it affects a small numbers of babies who have frequent vomiting AND other symptoms like: 

  • choking, coughing or wheezing during feeds 
  • vomiting up blood 
  • distress during feeds or refusal to feed 
  • poor weight gain or weight loss. 

If your baby has any of these symptoms, or you have any other concerns, discuss them with your doctor. 

Treating GORD with medications 

If your baby has reflux, but not GORD, there are no medications that can help. 

Babies with GORD are sometimes given medications to help reduce stomach acid. There are 2 types of these medications: 

  • Proton Pump Inhibitors (PPIs) (such as Losec or Nexium) 
  • H2 Receptor Antagonists (H2RAs) (such as Zantac). 

As with any medication, there are potential risks and side effects for babies. Discuss any concerns you may have with your doctor or nurse. 


Having a baby with reflux or who cries a lot can be challenging and worrying. Although there are no medications available for reflux, it is reassuring to know that most babies naturally outgrow it as they grow older.  

These strategies may help in the meantime: 

  • Remember, if your baby is vomiting but is otherwise happy and growing well, there is no need to worry. 
  • Keeping your baby upright for 10 minutes after a feed may help. 
  • Use a diary to take note of how often your baby is crying and vomiting and when it is happening, that way you can keep an eye out for any changes and discuss any concerns with your doctor.

Useful Links 

Australian Breastfeeding Association 

Safer Care, Victoria 

Royal Children's Hospital 

Canadian Premature Babies Foundation

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Disclaimer: This publication by Miracle Babies Foundation is intended solely for general education and assistance and it is it is not medical advice or a healthcare recommendation. It should not be used for the purpose of medical diagnosis or treatment for any individual condition. This publication has been developed by our Parent Advisory Team (all who are parents of premature and sick babies) and has been reviewed and approved by a Clinical Advisory Team. This publication is not a substitute for professional medical advice. Miracle Babies Foundation recommends that professional medical advice and services be sought out from a qualified healthcare provider familiar with your personal circumstances.To the extent permitted by law, Miracle Babies Foundation excludes and disclaims any liability of any kind (directly or indirectly arising) to any reader of this publication who acts or does not act in reliance wholly or partly on the content of this general publication. If you would like to provide any feedback on the information please email [email protected].