How Do I Know If My Baby Has Reflux or Colic?

Your previously easygoing newborn is now crying and more fussy than usual. You’ve gone to see a healthcare professional, but they’ve reassured you that your baby is perfectly healthy. 

While that’s great news, you’re still left with a crying baby. You may be wondering — could this be the start of reflux or colic? And how can you know the difference?

Let’s take a closer look at these two very common conditions and how you can tell the difference between colic vs. acid reflux. 

What is acid reflux in babies?

Gastroesophageal reflux (GER) — the proper term for acid reflux in babies — happens when acid and formula or breast milk move from the stomach into the food pipe (esophagus). 

A muscle called the lower esophageal sphincter separates the esophagus from the stomach. Normally, this band of muscle squeezes shut after a person eats so that food and fluid doesn’t move from the stomach back into the esophagus. 

This muscle isn’t fully developed during a baby’s first few months of life. So, formula and breast milk can come all the way up and out through the nose and mouth. The semidigested, chunky white stuff that comes up is often called spit-up.

Because all babies naturally have some reflux, experts consider GER to be a normal process. 

But GER and GERD (gastroesophageal reflux disease) are not the same thing. GERD means spit-ups are causing problems for your baby. For example, babies with GERD may have trouble eating and gaining weight because of pain. 

What are some symptoms of acid reflux (GER) in infants?

Spit-ups are the classic symptom of infant reflux or GER. Spit-ups usually start when a baby is about 2 weeks old. At this point, a baby is eating enough to fill their stomach. The pressure in the stomach can cause the liquid to flow back up the esophagus.

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Spit-ups worsen when babies are 4 to 5 months old. After that, spit-ups start to improve because the lower esophageal sphincter gets stronger. Babies also start to eat solid food around this age. Solids are denser so they don’t flow back up the esophagus as easily as liquids. Babies usually stop spitting up when they are about 1 year old. 

While all babies spit up, some babies do so more often. And some babies have large spit-ups, too. Some things that can cause larger spit-ups include:

• Changing positions too quickly during or after a feeding

• Swallowing too much air when eating

• Eating a large volume of formula or breast milk all at once

• Overstimulation (think bouncing or tickling) after feeding

What is silent reflux?

Silent reflux is when a baby experiences acid reflux (GER) but doesn’t spit up. 

In silent reflux, breast milk or formula travels from the babies’ stomach and into the esophagus (food pipe) but doesn’t come out of the baby’s mouth. Sometimes the baby swallows the reflux. 

But sometimes the reflux travels into the baby’s throat. This acid in the reflux can irritate the baby’s throat and nasal passages. It may even travel down into the baby’s voice box (larynx) and cause irritation. This is known as laryngopharyngeal reflux.

Laryngopharyngeal reflux can cause symptoms like:

• Hoarse cry

• Noisy breathing (stridor)

• Chronic congestion

• Cough

How can you tell if your baby has normal infant reflux or GERD?

Normal baby acid reflux (GER) may be messy, but your baby shouldn’t be bothered by it. If your baby is bothered by their spit-ups, that’s a sign they could have GERD. Signs of GERD include: 

• Crying and back arching during or right after feeding

• Trouble feeding or refusing to feed

• Spitting up more often or forcefully

• Wheezing or coughing during or after feeding

• Trouble gaining weight or gaining weight more slowly than usual

Talk with your child’s primary care provider if you notice any of these symptoms. Your baby may need to start treatment for GERD to ease their pain. This will allow them to eat comfortably so they can grow. 

What causes colic in babies?

Colic is a term used to describe excessive crying in infants. Colic has been a mystery for parents and healthcare professionals for decades. Even though it’s very common, it’s still not clear why some babies get colic. 

Researchers think colic may be the result of several factors. Gut maturity, which can affect how the intestines move and absorb nutrients, probably plays a role. Differences in the gut microbiome may also contribute to colic. 

What are common colic symptoms?

The classic symptom of colic is increased crying. Colic is defined as an otherwise healthy infant who cries for: 

• More than 3 hours each day

• At least 3 days per week 

• At least 3 weeks 

Crying might be worse in the evening or at night for some babies. 

Like reflux, colic usually starts when a baby is 2 weeks old. It can get worse until a baby is about 6 weeks old. Colic usually goes away when babies are 3 to 6 months old. 

How can I tell the difference between colic and GERD?

Both GERD and colic share crying as a major symptom. They also start and end around the same ages. But GERD and colic are very different. 

GERD is a medical condition that can affect a baby’s ability to eat and grow. Babies with GERD often need treatment.

On the other hand, babies with colic will thrive, even if they have significant colic. They need extra attention, support, and patience. But they don’t need medication or any other treatments. Their colic will go away as they get older and their gut matures.

So, how can you tell if your baby has colic or needs medical attention for GERD? Your child’s symptoms can give you important clues.

Some signs your baby has GERD include:

• Increased crying during or after feeds

• Spit-ups that cause crying 

• Back arching during or after feeds

• Refusing to eat

• Slowed (or no) weight gain

If your baby has colic, you might notice:

• Crying episodes that are worse at night

• Crying episodes that are random and not usually associated with eating

• Normal desire to eat

• Normal weight gain and growth

But sometimes, things aren’t so clear-cut. And babies can have both colic and GERD at the same time. Talk with your child’s primary care provider if you notice increased crying episodes, especially if those episodes happen during or after feedings. Your child’s healthcare team can help you figure out if your child has GERD or colic.

Are there treatments for infant reflux?

If your baby has GER, they don’t need any treatment. Their spit-ups will usually improve with time. Some things you can do to help lessen spit-ups include:

• Feeding in a more upright position

• Not lying your baby flat for about 10 to 15 minutes after feeding

• Trying a slower-flow nipple 

If your baby has GERD, your child’s primary care provider will recommend treatment. Treatment will make your baby more comfortable and allow them to eat, gain weight, and grow. Examples of treatments include the following.

Medications 

Antireflux medications, like proton pump inhibitors (PPIs) or histamine-2 receptor antagonists (H2 blockers), can help improve your baby’s symptoms.

Formula changes or diet changes

If your baby is formula feeding, your child’s primary care provider might recommend a hydrolyzed formula. If you’re nursing, they may recommend cutting certain foods from your diet. 

Positioning changes

Keeping your baby upright as much as possible can help ease some symptoms. But don’t use positioners or other devices to prop your baby during sleep — even if they have GERD. These devices aren’t part of a safe sleep environment and can raise the risk of sudden infant death syndrome (SIDS). 

Are there treatments for colic?

There’s no cure for colic. And there’s good evidence that treatments help colic go away faster.

Research shows that the best approach is to use things that soothe your baby. For your baby that might be swaddling, rocking, walking, or using a pacifier. 

Changes to a baby’s diet don’t usually help colic symptoms, and you shouldn’t give your baby homemade formula. For some babies, hydrolyzed formula helps with colic symptoms. Your child’s primary care provider can give you a prescription for these formulas. Keep in mind that it will take at least 2 weeks to see effects from a new formula. 

Research on probiotics for colic is mixed. Right now, experts don’t recommend routine use of probiotics for babies with colic. 

Research also shows that products marketed as “colic relievers” don’t seem to help most babies. Some products are not regulated by the FDA and may contain ingredients that aren’t safe for babies. It’s best to review any products with your child’s primary care provider before giving it to your baby. 

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Written by:

Meredith Grace Merkley, DO, FAAP

Dr. Merkley is a licensed, board-certified pediatrician who has over a decade of experience working in community health. She is currently a National Health Services Corp scholar, and is serving as the medical director of a school-based health clinic at a federally funded health center.

Edited by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

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