The Best Formulas For Reflux & Spitting Up (2024 Guide)

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Does your baby spit up frequently after feeding? Acid reflux, or a condition wherein food and stomach acid back-flow into the esophagus and throat, is common for young babies. In this in-depth and parent-friendly guide, I explain what causes acid reflux, how mild and severe cases differ, and I will share the list of the best acid reflux formulas to help your baby be comfortable, grow, and thrive. 

Finding the best baby formula for your little one can be stressful, but if you need to find an acid reflux or hypoallergenic one, the process is even more difficult. I know how confusing it can be to try to figure out what is causing your baby’s reflux! And, even once you discover the cause, it’s equally confusing to make sense of all the different acid reflux-related formulas available, and figure out what really is the best baby formula for reflux.

Many babies spit up – it’s a normal part of infancy (source). Sometimes, however, it may seem like your baby barely keeps anything down or you may be concerned about their failure to gain weight or grow because they are spitting up so much. 

So when do you know if your baby’s spit up is something to be worried about? In this post I will review what infant acid reflux is, the differences between normal and mild reflux and severe reflux, when you need to be concerned and see a doctor, and the best anti reflux formulas on the market today. 

But First, A Disclaimer

As a board certified health coach and certified nutritionist, I support products and ingredients that are rooted in science and are evidence-based. Using my background in nutrition, along with extensive research, consultations with experts, and my own experience giving my two kids formula, I was able to arrive at this list of the best formulas for acid reflux in this guide. This guide has also been medically reviewed and fact-checked by Christina Badaracco, MPH, RDN, LDN. (see my about page for more info about Christina).

Though I may receive a commission (at no extra expense to you) if you purchase through some of the affiliate links provided, I only recommend products I’ve researched, evaluated, consulted experts on, and would feel comfortable giving to my own two children. 

As always, I only share products that are the highest quality and that can help you and your family the most. By purchasing any of these products from the links below, you help keep this blog running, so thanks for your support!

Keep in mind that every baby & situation is different, especially when it comes to reflux, so always consult your child’s pediatrician to diagnose and treat reflux before starting or switching to a new formula. My recommendations are not a substitute for professional medical advice, diagnosis, or treatment.

What Is Acid Reflux? 

Infant acid reflux is when a baby spits up recently consumed liquid or food (source). Specifically, the food or liquid consumed reaches the stomach but then returns back up to the esophagus, or the feeding tube that connects the throat to the stomach (source). More than half of all babies experience gastroesophageal reflux (or GER) within the first 5 months of life (source); such reflux usually develops by 3 weeks of age and is resolved by the time babies are 12 to 18 months (source).

Acid reflux occurs at high rates in infants because the esophageal sphincter (or valve) that prevents food from flowing from the stomach to the esophagus is not developed or strong enough yet to hold in all of the stomach’s contents (source). Acid reflux can also be caused by lactose intolerance when babies lack the enzymes necessary to digest lactose in infant formula (source), or milk allergies when they cannot digest the complex proteins found in baby formula (source).

The most common form of reflux is called gastroesophageal reflux (GER) and looks like regurgitating or spitting up liquid or food. If babies are gaining weight and developing normally, this form of GER isn’t typically a cause for concern. In this mild form, babies are often relieved after spitting up, as doing so releases pressure in their digestive tract (source). Because of this, GER is also referred to as “happy spitter” or “milk reflux.” 

Occasionally, GER can develop into gastroesophageal reflux disease (GERD), a more serious and long-lasting form of reflux. When suffering from GERD, the reflux episodes are persistent enough to irritate or cause damage to the lining of the esophagus (source). This irritation and damage often results in a reduced desire or ability for your baby to feed which then interferes with their growth and development (source). 

A third type of reflux is silent gastroesophageal reflux disease (silent GERD). This form is “silent” because outward symptoms of the reflux are not always present. That is, the contents of the stomach only reach the esophagus and are not expelled from the mouth, making it tricky for parents and medical providers to notice and diagnose (source). 

Note: Though vomiting and GERD overlap, they are not always the same. Some people interchangeably use the terms “vomit” and “spit up,” but vomiting is more forceful and is a larger amount (source). Spitting up is smaller in quantity (even though it can look like a lot) and doesn’t project as much, even if your baby does so more forcefully. If your child consistently projectile vomits or if their vomiting seems unrelated to acid reflux, it is important to talk to your baby’s doctor (source). 

Symptoms Of Severe Acid Reflux In Infants

Now that we have explored the different types of acid reflux, how are you to know when your child has GERD, not just milk reflux? 

The following is a list of the most common symptoms of GERD (source 1, source 2). If your child exhibits any of these, promptly make an appointment with their pediatrician, as they can indicate a serious condition: 

• Refusal to eat or poor feeding
• Isn’t gaining weight or is losing weight 
• Looks to be in pain during or after eating: cries, arches their back, or is irritable 
• Coughing, choking, or trouble swallowing
• Wheezing, or difficulty breathing 
• Blood in stool
• Stools that resemble coffee grounds 
• Green or yellow spit up
• Blood in spit up 
• Hoarse crying 
• Baby’s belly is swollen, feels hard, or is distended

Treating Acid Reflux In Babies

If you anticipate that your baby has reflux, always speak with your child’s pediatrician to develop a treatment protocol. Depending on the severity or cause of their reflux symptoms, their doctor may include some of the following treatments: 

Mild Reflux 

To treat “milk reflux” or GER, your doctor may recommend any of the following treatments. 

Smaller Feedings: Decreasing the amount of milk at each feeding while increasing the frequency can control the volume of food in your child’s tummy. Having less volume in the stomach at one time can reduce the likelihood of reflux (source). 

Upright Feedings: To reduce the chances of regurgitation, feed your baby upright and keep them upright for 30 minutes afterward. Gravity can help keep the liquid in your baby’s stomach.

Adjusting Bottle Nipple Size: Too strong of milk or formula flow can give your baby too much fluid too fast. Your doctor may recommend decreasing your nipple size to slow your baby’s feeding rate. Furthermore, always keep the nipple full of milk as your child feeds. Ingesting air as they drink can cause feeding discomfort and increase their spit up frequency. 

Thickening Formula: Some specialty formulas are already pre-thickened, and some people may add rice cereal to formula to thicken it. These are two very different methods, and only one is recommended. For formula-fed babies, some anti-reflux formulas will add additional starch to thicken it up slightly, making it harder to regurgitate (source). However, I don’t recommend adding rice cereal to formula directly, as it can be a choking hazard and can cause other complications with feeding (source).

Frequent Burping: Burping more often will help your child release air that gets caught in their digestive tract, and reduce spitting up (source). If formula feeding, burp your baby after every 1-2 ounces.

Severe Acid Reflux (or GERD)

If your child is exhibiting symptoms of GERD, or severe acid reflux, your doctor may recommend switching to a different formula. This is because many formula brands are made with cow’s milk, and cow milk proteins are known to aggravate reflux in some children (source).

Some doctors may also recommend starting antacid medication (source) or running additional tests. In rare and extreme cases, your doctor may recommend that your child see a gastroenterologist for treatment or surgery. 

Note: Never start or switch formulas without speaking to your child’s doctor first. If you are concerned that your child has GERD, see your doctor first for diagnosis, a treatment protocol, and formula recommendations.

Switching Formulas To Treat Reflux 

If your doctor recommends that you switch your baby’s formula to treat reflux, they may recommend different types of formula depending on the severity and cause of it: 

• Happy Spitter: If your child is a happy spitter and isn’t in pain after spitting up, but your doctor is still concerned about their failure to gain weight, a formula created for acid reflux or a goat milk formula could be best for your little one. 
• Milk Protein Intolerance: The best formulas for milk protein intolerance or cow milk protein allergy are hydrolyzed protein milk and A2 milk formula. Hydrolyzed infant formula, often called hypoallergenic formula, is made with broken-down proteins that are easier for your child to digest. A2 milk-based formulas, such as goat milk formulas, are made with a different type of casein protein that is also known to be easier on digestion.
• Lactose Intolerance: If your doctor determines that your child’s reflux issues stem from not tolerating lactose, the primary carbohydrate in many infant formulas, your doctor may encourage choosing a formula without lactose, such as dairy-free, plant-based, or soy-based formulas. 

Best Formulas For Reflux 

Now let’s get into the best formulas for acid reflux! 

• Acid Reflux / Spit Up And Colic: This category of formulas is designed specifically for babies with acid reflux. Many of the formulas are made with thickeners to help the milk stay down, reducing regurgitation, and a few others are made with broken-down, or hydrolyzed, proteins. Though some of the formula brands say “AR” on the box, not all of them will. 
• Goat Milk & A2 Milk Formula: The A2 milk protein found in goat milk is easier to digest than the A1 protein found in most cow milk (source), making it an easier-to-digest option. Since both goat milk and A2 milk formula are made with A2 proteins, I’ve added A2 cow milk formulas to this category as well. 
• Hypoallergenic Formula: Instead of being made with more complex milk protein, hypoallergenic formulas are made with broken-down or pre-digested proteins or amino acids to make the formula easier for babies, especially those with cow milk allergies, to digest (source). 
• Lactose-Free Formula: Since most formulas are made with lactose as the primary carbohydrate, lactose-free formulas are a great option for any babies diagnosed with lactose intolerance.

Acid Reflux / Spit Up And Colic

Hypoallergenic Formula 

RELATED: BEST HYPOALLERGENIC BABY FORMULAS

Goat Milk & A2 Milk Formulas

RELATED: BEST GOAT MILK BABY FORMULAS

Lactose-Free Formulas 

RELATED: BEST PLANT-BASED AND VEGAN BABY FORMULAS

FAQs

Final Thoughts 

Whether it is your first time as a new parent, or your fifth child, being the parent of a newborn is tough. With sleep deprivation and potential hormones factoring in, I know how hard it can be to figure out what behaviors and situations are worth worrying about and which are part of normal and healthy early infancy.

Remember that spitting up is usually a normal part of this period. If you have any concerns about your child having gastroesophageal reflux disease (GERD), there are treatments and formulas that can help. As a first step, make sure to always bring your questions and concerns to your child’s pediatrician and they will help you determine the best course of action for your child. I hope this guide helped you navigate the world of anti-reflux formulas!

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