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Gastroesophageal reflux (GER) and Gastroesophageal Reflux Disease (GERD)

          GER is a condition, not a disease.  It only means, that a gastric content (formula, food, gastric juice) returns back, above the stomach.  It may cause some complications, and then it is called GERD.

Regurgitations or spitting up (GER) are non-forceful events and rarely a sign of GERD or any disease, provided that the baby is well otherwise.  It must be differentiated from vomiting - forceful events, and often considered as a sign of a disease.

         Most of infants (and 5-10% during the second year of life) do spit up and sometimes do it often. The common cause of it is overfeeding, but there are other predisposing factors related to an anatomy, physiology, quantity and quality of food (formula).  It doesn’t usually mean that they have a disease (GERD). Special tests and medications in the majority of such cases are not needed, but there are some exceptions: 1)neurologically impaired infants; 2) infants who do not thrive; 3) those who have respiratory problems.

There are some other red flags too, and a pediatric gastroenterologist may need to be consulted in some cases.


The therapy of GER is a combination of reflux precautions (to be discussed with your primary physician).

Older children:  By the end of the second year of life an occasional regurgitation episodes, especially after large meals or during cry,  do not usually mean that the child require any tests, procedures, or medication.  Daily episodes of regurgitations by this time do require attention of a specialist in order to rule out GERD, and it is a time to consider special tests and/or procedures.

Children above the age of toddlers (over the 3-d year of life) should not regurgitate food, and those who do, even occasionally, always require a consultation by a specialist, special tests and often procedures (endoscopy).

At any age… complains of a chest discomfort, difficulties to swallow food (usually solids), vomiting, anemia, weight loss, abdominal pain, respiratory distress in association with GER, requires  a prompt consultation of a gastroenterologist.


Foods to Avoid with the Acid Reflux Diet


Fruits and Fruit Juices

Oranges*               Lemons*                             Cranberries*

         Grapefruits*                 Tomatoes*


Mashed Potatoes                           Raw Onions*

French Fries*                                  Potato Chips*


Ground Beef                                       Marbled Sirloin*

Chicken Nuggets*                              Buffalo Wings(Spicy)*


Sour Cream           Ice Cream

Milk Shakes          Cottage Cheese      All regular cheeses


Macaroni and Cheese  

Spaghetti with Red Sauce*

Beverages Tea and Coffee* (Decaf or Regular)
Fats and Oils

Salad Dressings* (Creamy, Oil and Vinegar)

Sweets and Desserts

Butter Cookies         Brownies*             Chocolate*

Doughnuts               Corn Chips        

     * = particulalry important to avoid


   IN GENERAL, please avoid any "junk foods" and/or fast foods that are greasy, spicy, and processed.

Reflux precautions:

a complex of measures, which are used both as

a prophylaxis and a therapy of GER.


  • Diet (as above).
  • Eating smaller portions of food, frequent feeding of infants with smaller portions of breast  milk or formula.
  • Position in a bed (in a crib, for infants) 30 degree head side up.  Holding an infant for (at least) 30 min. upright after a feeding, and avoiding a horizontal position after a meal for 2 hours in older children, and 30 min. in infants.


Surgical therapy:  is rarely needed, but in some cases of severe GERD (gastroesophageal reflux disease), unresponsive to a full range of conservative measures, surgery may be necessary.

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