RHR: How to Treat Acid Reflux in Babies without Drugs
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RHR: How to Treat Acid Reflux in Babies Without Drugs

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Revolution Health Radio podcast, Chris Kresser

In conventional medicine, they start with the symptoms. So for example, if a baby has acid reflux, they prescribe a drug that just suppresses that symptom, without doing any investigation into why the reflux is occurring in the first place. There are so many problems with that approach. One of the main ones is that drugs don’t just have intended effects, they also have unintended effects. If a drug suppresses acid production, what else is it doing that may not be beneficial? What are the effects of acid that are beneficial?

Note: The Prescript-Assist supplements discussed in this article are no longer available. Please click here to learn more about a substitute, the Daily Synbiotic from Seed.

In this episode, we cover:

9:43  The causes of reflux
13:17  Four risk factors for reflux in infants
19:16  Why acid-suppressing drugs (PPIs) may not be the best treatment
29:06  How to prevent reflux and GERD in babies
32:24  How to address acid reflux and GERD

Links We Discuss

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Steve Wright: Hey, everyone. Welcome to another episode of the Revolution Health Radio show. This show is brought to you by ChrisKresser.com. I’m your podcast host Steve Wright from SCDlifestyle.com. With me is integrative medical practitioner, New York Times bestseller, healthy skeptic, Chris Kresser. Chris, how are you doing?

Chris Kresser: Hey. I’m doing well, Steve. It looks like you’re in a different location there. I see a guitar on the wall, a beautiful picture. What’s happening?

Steve Wright: I just came out to visit our producer Jordan Reasoner, my business partner and great friend. I’m out here in Bozeman, Montana in his crib.

Chris Kresser: Nice. What are you guys going to get up to?

Steve Wright: We are going to just hang out with his kids and do some brainstorming together. Then we’re headed out into the woods this weekend to go elk hunting, four days, three nights. We’re going to backpack it way back into the Montana Mountains. We’ll just do some man stuff.

Chris Kresser: Awesome. You guys are doing the whole hunter-gatherer thing to the hilt?

Steve Wright: Yeah, we’re really both trying to get more in touch with the food chain.

Chris Kresser: Nice.

Steve Wright: Personally, my mission this year is to get an elk back in Colorado, and really honor the animals—from their habitat all the way to my plate.

Chris Kresser: It sounds awesome. Have fun.

Steve Wright: Thank you. What have you been up to?

Chris Kresser: A lot. 14Four, the new diet and lifestyle change program, is coming along really well. It looks like it’s going to be an October 14 or October 21 launch. We’ll talk about that more soon. I’m really excited about it. I’m also taking a lot of steps forward with the clinician training program, which I’m super excited about. It looks like we’re targeting a spring launch for the first module in the program, but there will be other modules that come after that. The more I do this kind of work, the more I see the need for that. I get e-mails from people almost every day, asking about clinician training and what kind of opportunities there are to learn a Paleo-oriented approach to functional medicine. There just aren’t many right now. So I figured, why not make one? I’m really looking forward to teaching people how to do this work. There’s such a huge need for it, as you know, Steve, and there’s not a lot of options out there. So look for that, if you’re one of those people who are interested, keep an eye out on the blog and e-mail list. We’ll keep you posted as that unfolds.

Steve Wright: Yeah, that’s really awesome. I know that people have been requesting that from you for many years now. There’s a huge gap there, and a lot of training needs to be developed. I’m very excited for this.

Chris Kresser: We have a great question today that I think a lot of parents are going to appreciate, in particular. Let’s give that a listen.

Lila: Hi. I was wondering if you could weigh in on the prevalence of acid blockers being prescribed to infants for GERD. This is commonly done in the pediatric practice that I work in as a nurse, and I kind of find it concerning. In addition to that, if you have any alternative theories on what the diagnoses and treatment should be for the GERD, that would be helpful. For instance, I don’t know if it’s possible for infants to develop SIBO or if it’s just gut dysbiosis, or what it is. But I have a hard time believing that we have an epidemic of GERD in newborn babies. Thanks.

Chris Kresser: This is a really good question, as I said. It’s one that I think a lot of parents will be interested in, as well as a lot of healthcare providers who work in pediatrics, work with kids. I definitely agree that we’re not seeing an epidemic of PPI deficiency in babies all of a sudden, after several thousand generations of getting along just fine without PPI. It’s pretty safe to say that we haven’t developed a PPI deficiency in young babies.

Steve Wright: What did we do before PPIs? I don’t know.

Chris Kresser: Well, it’s probably true that babies have had colic for a very long time. But to me, this question really gets at the deficiencies of conventional medicine. It’s funny that we were just talking about clinician training for functional medicine. This is really kind of a prime example of why we desperately need training for functional medicine, and we need to change our healthcare system. That’s because in the conventional model, all too often, they work from the outside in. What I mean by that is, in a functional medicine perspective, we look at the core underlying causes of problems—we can call these mechanisms. Then as we move out from a mechanism like blood sugar dysregulation or a gut issue like SIBO or leaky gut, that then leads to certain disease patterns like maybe diabetes or hypothyroidism or IBS—you know, all the diseases that we hear about. Then from there, we go out to symptoms, like gas and bloating in the case of IBS; agitation and mood swings with diabetes and blood sugar issues; or high blood pressure. In functional medicine, we start at the core. We address the underlying mechanisms and the environmental triggers that cause those mechanisms to happen, and that’s how we deal with the symptoms.

In conventional medicine, it often goes the other way around—they start with the symptoms. So for example, if a baby has acid reflux, they prescribe a drug that just suppresses that symptom, without doing any investigation into why the reflux is occurring in the first place. There are so many problems with that approach. One of the main ones is that number one, drugs don’t just have intended effects, they also have unintended effects. If a drug suppresses acid production, what else is it doing that may not be beneficial? Or even, what are the effects of acid that are beneficial? You know, there’s very little in our body that’s just there for the heck of it. It’s not like the only reason we have stomach acid is to make us suffer when we have reflux or GERD. There’s a reason we have stomach acid. So what happens when you prescribe a drug that reduces stomach acid production? It might alleviate the symptoms of reflux, but what else is it doing? We’re going to find out what it’s doing, and it’s not good.

The other problem with this conventional approach is if you take a drug that suppresses a symptom without ever investigating what causes that symptom, then that underlying cause is just going to persist and probably even worsen over time, which can then lead to other symptoms. Then you end up taking a drug for that other symptom. That drug causes a side effect, and wouldn’t you know, there’s a drug for that too. So you’re playing Whack-a-Mole, taking drugs for all these different side effects and then by the time the average person is 65 years old, they’re on four or five different medications. Some people are on up to 12, 13 different medications at that point in their life. This is the system that we’ve created, and it’s completely broken. This is why there’s such a desperate need for functional medicine and new practitioners that are practicing this style of medicine, and also, current practitioners in the conventional system that are starting to integrate some of these principles into their practice. So that’s a little tangent as to why I’m so excited about the functional medicine training. This is actually a really good example of how that is needed.

Steve Wright: Oh, it really is. Your enthusiasm is well-appreciated and I think that what we’re diving into today is going to be hitting home for a lot of people. Because I know even the people that have kids around me right now, some of them, I’ve watched their kids go through this exact scenario. And now they’re dealing with—you know, all of a sudden, they’re five, and now they have to put tubes in their ears. They have really crazy febrile seizures that seem like it’s just a kid who’s super sensitive. But when you back up and go right back to infant stage, already, right now, there’s kids presenting with a, “Hey, everything’s not okay yet.” So yeah, this is really important for young kids, all the way to old people.

Chris Kresser: Let’s first talk about the causes of reflux. Then we’ll talk about risk factors for reflux in infants. Then we’ll talk about why PPIs, acid-suppressing drugs, might not be the best choice. We’ll talk about what might be a better choice.

The Causes of Reflux

I have a whole eBook on GERD and heartburn on my website. It’s available for free. If you haven’t read this, I really encourage you to do that. Go to ChrisKresser.com. Go to “LEARN” at the bottom of the page. There’s a drop-down menu there that says “eBooks.” Click on that, and you’ll find the heartburn eBook. I go into a lot of detail there about what the real causes of heartburn are, so we’re not going to spend too much time on that now.

Essentially, what you need to know is that heartburn is rarely caused by excess stomach acid production. Heartburn is caused by a dysfunction of the lower esophageal sphincter (LES), which is what separates the esophagus from the stomach. Normally, that sphincter is supposed to stay closed. It opens when food goes down, when we eat food and swallow it, so that the food goes into the stomach. Then it’s supposed to shut, so that acid and bile don’t reflux back up into the esophagus. But what happens with reflux and GERD is that the competence of the lower esophageal sphincter is impaired. So it starts to open at inappropriate times, and acid reflux is up into the esophagus. That’s why acid-suppressing drugs can still work, even though the cause of heartburn is rarely excess stomach acid production. The PPI suppress acid production almost to nothing, in some cases, if the dose is high enough. So if you don’t have any acid at all in your stomach and your sphincter is still opening inappropriately, you’re not going to experience heartburn and reflux, because there is no acid left to reflux into the esophagus. I just want to clarify that, because sometimes people say, “Well, if heartburn is not caused by too much stomach acid, how come taking an acid-suppressing drug works?” That’s basically the answer.

The next obvious question is, what causes this dysfunction of the lower esophageal sphincter? Again, there are a lot of different answers that I cover in the full eBook. But one of the main ones is actually SIBO—small intestinal bacterial overgrowth. This leads to an overproduction of gases in the small intestine and the stomach, which can then put pressure on the lower esophageal sphincter and make it open inappropriately. Any kind of dysbiosis anywhere in the gut can contribute to this as well.

Another potential cause could be food intolerances. So if the infant is young enough and they’re being exclusively breastfed, this would be things that they might be exposed to like gluten in mother’s milk, if the mom is eating that and the baby is sensitive to it, or possibly dairy proteins, other food antigens. It’s less clear what gets into the mother’s milk or what doesn’t, but as I know, many mothers listening to this program can attest, the maternal diet does influence the baby in many ways. If a mother eats spicy food, for example, they might notice that their baby is really colicky or has digestive upset after that. Certainly, looking at the mom’s diet is a potential issue for infants that aren’t eating solid food. Then of course, for infants that are starting to eat food, we want to look at what they’re eating. Those are the basic underlying causes of reflux in infants. Again, there may be others, but these are the ones we’re going to focus on today. So what are the risk factors for reflux in infants?

Four Risk Factors for Reflux in Infants

One of the biggest ones is maternal antibiotic use during pregnancy. This can happen for a number of reasons: to deal with group B streptococcus (GBS), other infections that a mother might get, or even maternal antibiotic use prior to pregnancy. What we know now is that the mother’s gut flora profoundly influences the baby’s gut flora. Researchers used to think that the baby’s gut was completely sterile until they are born essentially, until they moved down the birth canal, where their first exposure to bacteria is in the vaginal canal—the baby gets exposed to both the vaginal microbiota and feces, and that was the initial colonization, and that totally determines the kind of imprint of gut flora that the baby gets. But there’s actually some recent research that suggests colonization of the baby’s gut actually happens in utero, or it begins in utero. So the status of the mother’s gut health, both prior to pregnancy and during pregnancy, is providing that initial imprint of the baby’s gut flora. So for people who are planning to conceive, women who are planning to conceive, it’s really crucial to do everything that they can to optimize their own gut microbiota prior to conceiving. That’s in an ideal world. Of course, not everyone knows this or has the opportunity to do this, so we always have to just start from where we can. But it’s never too late to pay attention to this.

The second thing would be the method of birth. We know from many, many studies now that Caesarean birth, that kids born via C-section, have different gut flora and less optimal gut flora than kids who are born vaginally. The reason for that is what I just mentioned. Whether or not colonization of the gut begins in utero, we know without a doubt that a major aspect of how the gut flora develops in the baby is from that exposure in the birth canal. And in a C-section birth, that obviously doesn’t happen. The baby is removed surgically and the first exposure that that baby is going to get is to basically ambient bacteria in the hospital environment, which is very different than the bacteria they’d be exposed to in the birth canal. They’ve done lots of studies, and found that babies that are born via C-section are more likely to develop obesity, diabetes, and other problems later in life. Of course, many women don’t go into the birth process saying, “Gee, I want to have a C-section.” C-sections happen. They’re lifesaving, in some circumstances, for both the mother and the baby. I’m not condemning emergency C-sections at all, but I am suggesting that elective C-sections are not a good idea, which are on the rise. You know, women choose to have C-sections because of the convenience of knowing exactly when their delivery date will be. And I am suggesting that there may be ways, by optimizing nutrition—like we talk about in The Healthy Baby Code—to minimize the risk of C-sections, by making sure that the birth process happens as naturally and optimally as possible.

Another risk factor would be how the baby is fed initially, so whether it’s breastfed or formula. Breast milk is the optimal prebiotic, probiotic food for infants, and that evolution over hundreds of thousands of generations has taken care of that. There’s not really any way that we can improve on breast milk. Breast milk, for example, contains galactooligosaccharides, which are prebiotic molecules that selectively stimulate the growth of bifidobacteria, which is one of the most important species of beneficial bacteria in the gut. Some formula producers are starting to get wise to this, and they’re adding some prebiotics to formula. But it’s never quite the same when you create a synthetic version. So far, I don’t think you can get the same outcome with formula that you can get from breastfeeding. Once again, there are a lot of women out there who want to breastfeed but can’t, for any number of reasons. This is not something to feel guilty about. There’s still a lot you can do to make sure that your baby’s getting what he or she needs. I’m more, again, addressing when we have a choice, when there’s a choice to breastfeed or feed formula. The research is abundantly clear, even in the conventional medical world now. Thankfully, they’ve gone back from the craziness of the ‘60s and ‘70s, where formula was the recommendation. They now pretty much universally recommend breastfeeding across the board. The World Health Organization (WHO), in fact, recommends six months of exclusive breastfeeding with no other food, and 22 months of complementary breastfeeding, which means continuing to breastfeed, at least in some level, for almost two years. Unfortunately, very few women do breastfeed for that long. But that’s what’s been determined to be optimal, even by groups like the World Health Organization.

The last risk factor we already talked about a little bit, and that’s food intolerances. Those food intolerances are typically related to these other risk factors that we’ve already talked about, like poor maternal gut flora, poor infant gut flora, and then being born via C-section and being formula fed. Those kids that fit into those categories are more likely to develop food intolerances in the first place. Okay, so now that we’ve talked about the causes, the risk factors, let’s talk about treatment and why PPIs may not be such a good idea.

Why Acid-Suppressing Drugs (PPIs) May Not Be the Best Treatment

As I’m sure almost everyone knows, who’s listening to the show, PPIs work by inhibiting stomach acid secretion. What some people may not know is that stomach acid, as I said before, is actually there for a reason. It plays some really important roles that don’t just involve making us double over in pain if it refluxes into the esophagus. Stomach acid initiates the process of digestion, when we eat protein in particular. All other foods get mixed around with stomach acid, and they become a substance called chyme, which is kind of a sludge-like substance, in a consistency that can then pass through into the small intestine, where the nutrients start to get pulled out even more. But nutrient absorption actually begins in the stomach. And there are numerous studies that show that acid-blocking drugs impair the absorption of all kinds of different vitamins and minerals. That’s not surprising when you know that stomach acid is required to absorb those nutrients in the first place. These include things like vitamin C, iron, magnesium, B12, folate, and other B vitamins. These nutrients are important for adults, but they’re even more important for developing babies. So folate and B12 in particular are needed to form new red blood cells, and they play an important role in methylation, which silences and activates gene expression, which, in turn, regulates just about anything in the body. Vitamin C is important for collagen development and the structural development of the body, in addition to immune function. Iron is also involved in red blood cell function. Without enough iron, babies will become anemic and not develop properly. Magnesium plays a role in over 300 different enzymatic reactions in the body, it’s one of the most important nutrients that we need. And all of the other B vitamins—B6; B5, which is pantothenic acid; B1, which is thamine; B2, which is riboflavin; B3, which is niacin—are all essential. Again, they’re all there for a reason. We need them. They’re all essential nutrients. And PPIs inhibit their absorption. We could potentially see an increase in things like neurological issues from B12 deficiency; problems with development, like I said, of the structural tissue in the body from vitamin C deficiency; behavioral disorders like ADHD, autism, et cetera because of folate and B12 deficiency. These things are on the rise in kids. There may not be enough kids now taking PPIs that this is making a significant contribution, but this could certainly happen if we continue with our current course.

Another important role of stomach acid is to prevent infection. We’re exposed to bacteria, viruses, and fungi all the time. They’re all around us in the environment. But a lot of times, if we get exposed to them through food or water that we swallow, the stomach acid just takes care of that. Many of these organisms cannot survive in a really low pH, acidic environment like the stomach. The stomach acid is our first line of defense against these organisms entering through our mouth and when we swallow. As you might suspect, PPI use has been associated with an increased risk of infections of all types, but particularly gut infections and something like Clostridium difficile, which is a potentially fatal gut infection. Very serious. It’s a cause of concern. It’s been shown that there’s an increased risk of community-acquired pneumonia in people using PPIs. Back to the nutrient absorption issue, PPIs have been associated with decreased bone mineral density, because calcium absorption is impaired, and also maybe the fat-soluble vitamins—like vitamin D, which plays a role in calcium metabolism, and K2.

Yeah, I know. It’s kind of ridiculous. It’s like one of those commercials, where at the end of the commercial, they say, “This drug is…” It goes on for like 30 seconds with the elevator music playing in the background. It’s like, I can’t believe anyone would buy this drug after hearing this. PPIs have been shown to increase the risk of SIBO. So that’s pretty ironic, right? SIBO is one of the underlying causes of reflux in the first place, and PPIs have been shown to increase the risk of SIBO. Then SIBO is also associated with everything from skin issues like eczema, to cognitive and behavioral issues, to malabsorption. A lot of things that show up in kids, right? A lot of kids have eczema. It’s one of the most common problems. In my work with young children, I found that eczema is almost always related to gut issues. And when we address the gut stuff, the eczema goes away. Perhaps most ironically, as I said, SIBO is associated with GERD and reflux. There’s even a paper in the scientific literature—I nearly spit on my coffee when I came across it—that was called Evidence That Proton Pump Inhibitor Therapy Induces the Symptoms It Is Used to Treat. I mean, that’s a paper you don’t even need to read, really, right? That’s such a great title. It pretty much says it all. But of course, I did read it. They talk about some other interesting mechanisms by which PPIs can actually induce acid reflux.

PPIs increase gastric pH, which means they make it less acidic and more alkaline. This, in turn, substantially increases the concentration of something called gastrin. Then gastrin promotes the release of histamine, which, in turn, provokes increased acid secretion. This will lead to a rebound effect after stopping PPIs, where more acid is produced. The gastrin actually causes a growth in the tissue that produces stomach acid. So when you stop the PPIs, you’re producing more acid than you were before you started taking them. This rebound effect has been documented, and it’s been shown to last for at least four weeks, possibly longer, because they ended the follow-up period after four weeks, and many of the patients were still experiencing symptoms at that point. We could go on, but I’ll just mention a couple other things, and then we’ll talk a little bit about alternatives.

PPIs are also associated with weight gain over the long term, in adults at least. One study in adults showed an average increase of about 10 lbs in weight in about 70% of patients that were taking PPIs over a two-year period, whereas only 9% of patients in the control group gained weight over that period. That’s pretty significant and alarming, especially given childhood obesity rates on the rise. I mean, even the FDA cautions against the long-term use of PPIs. It’s a real problem. They were never approved for long-term use. That’s an interesting little historical note about PPIs, is they were initially only approved for short-term use. They were never intended to be taken for years and years. I just got an e-mail this morning from someone who has been on Nexium for 30 years, 35 years I think he said. He’s wondering how to get off of it. That’s just a complete, huge mistake, an oversight by the FDA and other regulatory agencies, and just another problem with the way that our system is constructed. You know, doctors made those prescriptions, and people just kept taking them for years and years, with no approval for that kind of activity.

Steve Wright: Last time I checked, eight weeks was the length.

Chris Kresser: Yeah. Eight weeks maximum.

Steve Wright: Yeah, maximum.

Chris Kresser: Let’s talk a little bit about what else to do. Because one thing I want to say here is thankfully, Sylvie didn’t really ever deal with reflux or GERD. But like you, Steve, we’ve been around some friends and parents who have a baby that’s suffering from GERD, and it is not easy. It is extremely difficult to see anyone who has a kid, even just seeing a kid have a bad cold or something—it’s really hard to watch your child suffer. And it’s hard on the parents if it’s interrupting their kids’ sleep. I completely understand the desire, and the willingness, even, of parents to give their children PPIs if it will help relieve the pain and restore some sense of normalcy in the house. I’m not condemning parents for this at all. There’s just very little discussion of alternatives or the real causes in the community, which, of course, gets back to the whole thing about the need for functional medicine training. Okay. Let’s talk about how to prevent reflux and GERD for mothers who haven’t given birth yet or people who are still in the family planning stages. Then we’ll talk about how to address it if it’s already there.

How to Prevent Reflux and GERD in Babies

Not surprisingly, how to prevent it is just sort of the reverse of the triggers and how to get it, which means optimize your gut flora. There’s a study that I just read called Can Nutritional Modulation of Maternal Intestinal Microbiota Influence the Development of the Infant Gastrointestinal Tract? Translation—can what a mom eat improve the gut flora of her baby? The short answer was a resounding yes. They went through all these different mechanisms for how a mom changing her diet actually directly impacts the gut flora of her baby. So that’s number one, is making sure that mom is doing everything that she can to optimize her gut health. I talk a lot about that in my book, Your Personal Paleo Code (published in paperback as The Paleo Cure in December 2014) which is going to be relaunched in paperback as The Paleo Cure at the end of this year. There’s another free eBook on my website that’s all about gut health. You can get some tips there if you’re new.

Another thing is probiotics and prebiotics can be helpful for improving mom’s gut flora. In an ideal world, we wouldn’t need to take those. But let’s face it—we don’t live in that world, we live in a world that is hostile to gut health in so many different ways. And many of us took a lot of antibiotics when we were young. We might have been born by C-section. We might have been fed formula, especially if you’re in my generation that was raised in the ‘60s and ‘70s, where breastfeeding was kind of out. So some probiotics, prebiotics: things like Prescript-Assist, which I sell in my store, I have a lot of success with, and is a great choice; Prebiogen is a great prebiotic; resistant starch, which we talked about a lot, like potato starch; fermented foods like sauerkraut, kefir, kimchi, beet kvass. All this stuff can be really good for restoring good maternal gut health.

Another thing would be vaginal birth whenever possible. Of course, there are situations where a C-section becomes necessary, but you want to do everything you can to have a natural birth. You want to breastfeed and you want to breastfeed exclusively for six months and in a complementary way for 22 months optimally, if you can. I realize that’s hard for some women who have full-time jobs outside of the home. You know, there’s always the ideal and the actual. But those are the guidelines, that’s the recommendation. Even if you can’t breastfeed, there is an increasing number of donor milk banks available, where you can actually purchase milk from women who have a surplus of milk. This is the preferred, what I would suggest investigating first, if for whatever reason, you can’t breastfeed and you can’t pump your own milk.

Then, of course, mom needs to avoid any of her own food intolerances. If you’re gluten intolerant, you obviously don’t want to be eating gluten. If you’re dairy intolerant, you don’t want to be eating that. Then you would obviously want to remove those foods from your diet, to prevent any problems from occurring with the baby.

How to Address Acid Reflux and GERD

So let’s say you’re here, you have a baby, your baby has GERD, and you want to know what to do about it. Obviously, you would do everything that I just mentioned for prevention, it’s still a good idea to do all of those things. But in terms of treatment, there are a few different options.

Number one is there are several studies that have shown that probiotics can ease colic and reflux. One of these studies shows that babies who consumed probiotics during their first three months of life were significantly less likely to have colic in the first place. There have been other studies that have shown that probiotics have actually reduced colic, even after it exists. So some studies have found that it doesn’t, some studies have found that it does. Overall, the review papers suggest that probiotics are beneficial. One of the ones that I’ve recommended before on the show is Ther-Biotic Infant, which is Bifidobacterium infantis. It’s a probiotic that’s appropriate for kids under two years of age. Another probiotic that’s been studied quite a bit in infants is called Lactobacillus reuteri, R-E-U-T-E-R-I. That’s been shown to be effective for colic in some studies.

Another thing to consider is putting a little galactooligosaccharide in the baby’s diet. If you’re just breastfeeding, there are a few different options to get these things into your baby. You can lightly dust the nipple with Ther-Biotic Infant powder and also galactooligosaccharides. One product is called Galactomune, from Klaire Laboratories. It has galactooligosaccharides and beta-glucans. Galactooligosaccharides are in breast milk, but additional galactooligosaccharides may be helpful for increasing beneficial gut bacteria in babies that are having trouble. So you can lightly dust the nipple, or you can take some out of the container and put it on your finger, and just put your finger in the baby’s mouth. They taste neutral and fairly pleasant, like a mildly sweet taste almost, babies actually like them.

If the baby is eating solid food, you of course want to stick with a hypoallergenic, anti-inflammatory, Paleo type of approach. You want to probably try removing some of the foods that may cause problems, even if they’re healthy foods. Eggs is a big potential offender for really young babies. Even Sylvie, when she was six months old, egg yolks were one of the first foods that we introduced. She had a projectile vomiting episode after she ate her first soft-boiled egg yolk, which was pretty horrifying for us. Then we just waited. We said, “Okay, that doesn’t work.” We went on to liver, which she loved. Then we went back to egg yolks about a month later, and she had no problem then, and still has no problem with them. So sometimes kids are sensitive to foods initially. Things like eggs, dairy—all of the ones that we look for as adults are also likely to aggravate kids, in some cases. You want to do some experimentation there. Obviously, removing gluten, gluten-containing grains, grains in general, processed and refined flour, legumes, things that can aggravate poor digestion should be removed. That can often make a big difference as well. That’s where to start. Fortunately, babies and young kids in general tend to respond really well to dietary interventions and probiotics and prebiotics. They haven’t had as many years to become damaged as we have as adults. They’re easy to work with in a certain way, because they respond so quickly. They’re hard to work with in that they can’t tell you exactly how they’re feeling and what the response is, but they tell you one way or another. Anyone who’s been around a baby with GERD, they’re telling you if they have it.

Steve Wright: So what happens, Chris, if the probiotics, the prebiotics, and the dietary changes don’t work? What’s the next best step, for a parent out there listening to this?

Chris Kresser: Well, there’s not really a clear alternative to acid-suppressing drugs for the acid suppression itself. In adults, as you know very well, we do things like give hydrochloric acid (HCl) in pills. You obviously can’t do that with infants. Infants are not going to be able to swallow HCl capsules. And you certainly can’t open an HCl capsule and put it in the infant’s throat. Please do not do that. That’s corrosive. The acid will damage the esophagus. So there’s no easy way to get things into the baby that can replace stomach acid.

Steve Wright: Is there any bitters that might work?

Chris Kresser: Swedish bitters may be an option. Apple cider vinegar may be an option too. I would probably explore that before I considered PPIs. But to be honest, Steve, I’ve yet to have a baby that didn’t respond to diet intervention and probiotics and prebiotics, and also changes in mom’s food intake, probiotic, and prebiotic status.

Steve Wright: Just one last thing in this. So it’s happening right now, you can’t change the diet right now, the baby is going nuts. I know in adults, we can give baking soda, to help with the acid suppression. Is that something that might be used in a pinch for a baby? Or is that another one of the adult things that we do not use in infants?

Chris Kresser: Well, I don’t actually know the answer to that. I’ve never done that, and I would have to look into it before giving a clear answer. I don’t want to mislead anybody. But maybe we can come back to that. We can talk about that on a future show. I think ultimately, if you have to do a PPI for a period of time just to get some relief for everybody involved, you just want to minimize that as much as possible, because of the potential for rebound reflux that we talked about earlier, and because of the other issues with PPI use over the long term. And you want to make sure that they baby’s nutrient intake is adequate during that period or above adequate, because of the way that PPIs can interfere with nutrient absorption. I hope that helps. It does require a bit of trial and error in the whole process, but it’s worth it to avoid being on a long-term, acid-suppressing drug. Thanks again for your question. We’ll see you next week.

Steve Wright: Thanks, Chris. I can tell you’re pretty passionate about this subject, and it was a very informative show. Thank you, everyone, for continuing to send us your questions. In-between episodes, if you haven’t already, make sure you’re on Chris’ e-mail list. That’s where he’s going to be sending out his latest articles. If you haven’t gotten things like his heartburn book or his gut health book, you’ll want to be on the e-mail list for updates regarding that kind of thing. Then you can also just Google Chris Kresser and gut health, or Chris Kresser and heartburn, and you’ll pull up those eBooks that we referenced in the show. They’ll also be in the show notes. Lastly, if you’re not following Chris yet on Facebook, go to Facebook.com/ChrisKresserLAc and Twitter.com/ChrisKresser, if you want to be up to date on these new studies that he’s always reading and staying up to date with. That’s where to go to get the latest research. In the meantime, thanks for listening.

  1. I know this thread is a bit old do I’m not sure I’ll get a response. I’m just surprised that Chris didn’t mention how babies may simply have an immature lower esophageal sphincter which opens when it shouldn’t and this is why so many babies grow out of this condition as they get older and the LES strengthens.

    • Yes, thank you for mentioning this. I have just had my 3rd baby and she suffers from bad reflux, yet I have done everything he states should help to avoid reflux probiotics – good diet – no antibiotics – natural birth w no drugs- solely breastfed etc etc

      • I’m a pediatric nurse. It’s very true that babies have an immature lower esophageal sphincter, which tends to strengthen by roughly 6 months old. When this is the case, babies certainly can spit up, and what you SHOULD see is a “happy spitter”. That is, the baby that is spitting up is not in pain, as evidenced by constant screaming and arching of the back. When you see GERD, that is the type of reflux that causes pain. This is what Chris is talking about, and it is not normal. It absolutely CAN be treated by adding in the probiotics, prebiotics, and addressing food intolerances. I hope that helps!

  2. My baby had acid reflux and it was hard to cope with this trouble unless I started babies magic tea that soothed my baby within two days. I would recommend moms with same symptoms to try this tea that is organic and has no preservatives.

  3. Hi
    I have suffered in acidity from previous 5 years, but first it is not worse, but with the passage of time it become werse, and 7 month ago I was unable to eat foods, bread, just I spent my time of 7 month, just with milk, yogurt, barley, kichdi, etc, I took all kind of antacid, other eso operazol, operazol, zentic, but due these medicine there is side effect, but now i am not taking any kind of medicine, and I sufferd suddenly in acidity pain, its worse and unable to bear, some doctor say its acidity some say its ulcer, i didn’t examin with endoscopy still, some one guide me what should I do to get rid from acidity?? acidity can be cure permanently or its life time???
    I have some lumps in mouth and throat, some one can tell me why this lumps occure? is it due to acidity or ENT problem?? coz I have ENT problem too.

  4. Chris, have you had any experience with the cell salt nat phos (natrum phosphate) in treating reflux in babies? I’ve heard great things about it curing reflux in a matter of days. Are there any dangers that you know of to using nat phos?

  5. Hi Chris. Is it ok to do the Paleo diet with a 12 year old boy. I have read your book, your blogs and subscribed. He has been diagnosed with reflux which I know you can’t comment on, but I really want to help him without giving him the PPIs he has been prescribed. He was a C section, I did breast feed him, but then he has had countless courses of antibiotics for ear infections & tonsillitis right through from 2/3 years old to now. I do want to follow the diet but my Q is- how will it fill him up. He has a very good appetite (he is not fat) and is about to shoot upwards. He eats a huge amount of carbohydrate (bread & pasta). Stopping the sugar will be no problem but if I give him a breakfast out of the Paleo Protocol, he is hungry again an hour later. Please advise. Many thanks

  6. Hello,

    What are your thoughts on the differences between HMF Baby F probiotic and Ther-Biotic infant formula? I’ve been giving my baby HMF and more recently started adding BioGaia drops as well. Should I switch to Ther-Biotic? Also, is it safe to give two types of probiotics to a baby? In my case, the BioGaia along with HMF.

    Thanks!

  7. I am a mom who must feed formula to my baby. He has been diagnosed with acid reflux by his doctors and we have been giving him prescription medecide for the past 4 weeks. He is 12 weeks old, and we are still having trouble with his fussiness. I listed to your podcast today about baby acid reflux and was wondering if you have any suggestions for a formula that you would recommend. What I learned was life changing as we consider how to help our baby.

  8. Will you please clear up some confusion for me? In your 14Four program, you recommend taking probiotics that do NOT need to be refrigerated but it looks like the Ther-biotic Infant probiotics need to be refrigerated?

  9. Not sure that “elk” hunting is something that I would want to hear about when listening to a podcast, that you are actually looking to go out and kill elk.

  10. Chris,

    I purchased Ther-Biotic Infant and Galactomune powder for my 2 month old with reflux. Could you advise me on how much Galactomune powder I should be giving my baby?

    Thank you!

  11. My tips on how I completely cured my heartburn & acid reflux.
    Tip 1; an immediate relief is found via root ginger. Seems to neutralise the esophagus immediately.
    Tip 2; apple cider vinegar diluted with a bit of water and then down it. Every morning.
    Tip 3; have a look at the free video on solvehealthproblem.com/acidreflux and just follow the methods it gives you. Takes about a week but reflux symptoms will then be gone forever.
    Tip 4; dont push your luck! once you feel your symptoms have relieved still don’t be silly and have that greasy take away! Be cautious what you eat without it ruling your life.

    • Jenny, why drs fail to tell us what you just did I will never know. I had to research why my drugs were not working after only 3 days on them. I found the info on apple cider vinegar (braggs) and tried it. I honestly did not think it would do anything but the cough was keeping me up. It worked the first night. I take 2tbls before dinner once a day and have not had an issue for a year.

  12. I have a five year old daughter who has been suffering from GERD for two years. She also always has a distended belly about 30 minutes after eating. Her gastro insists she needs to be on Prilosec for 3 months and then predicts she will need it on and off throughout her life. Yikes! Your articles and videos have certainly educated me enough to know that Prilosec is likely not the answer. I have Betaine Hydrochloride with Pepsin (650 mg). Is it safe to give to children?

    • Leah, although I don’t have an answer to the immediate problem I’d like to share our experience. My daughter had GERD that was so severe and acute she was in full respiratory failure 5 times (her airway would actually swell and occlude). She did a few years of reglan and Prilosec, we elevated her bed etc. One doctor told us by the time she hit puberty this resolves completely for some girls-and it DID. She is now 30, an ICU nurse and a beautiful and healthy young woman. I hope only to give you the gift of just that-hope.

  13. Hi Chris, I have a short question with a long explanation to get to the question –
    I am in the middle of this with my 2 1/2 year old. He was a very colicy baby, although I never did PPI’s. By 18 months it became clear he had chronic loose stools. He’s been on a paleo diet since the beginning, and he does deal with eczema that comes and goes, and what food is causing it has been really tricky to pinpoint. We did a stool test a year ago, and he had dysbiosis – overgrowth of an opportunistic bacteria, and low good bacteria. I’ve done two rounds of different herbs (uva ursi which started to work, but caused a photo sensitivity so we discontinued & GSE which didn’t work) and then biocidin all while doing high dose probiotics. When these protocols didn’t work, I tried a low FODMAP diet, which reduced his massive tummy bloat almost immediately. We reconsulted with our naturopath, and she has now prescribed plant tannins (since the uva ursi seemed promising), biofilm defense, and belly binder by kan herbs. At the same time we have started the GAPS diet, and if I need to add more into it, it will be paleo low fodmap foods. I am hoping this combo of herbs with this stricter diet will do the trick. I’m wondering how long it has taken you to deal with these trickier issues in toddlers? I have a 6 month old that I’m exclusively nursing along with making him paleo baby food along with a 40 hour a week job. The GAPS diet prep, baby food making, along with trying to make food for my husband and I is exhausting! Just wondering if you had input on the length of time, and any other thoughts on this situation.

    • The good news is that generally young children respond much more quickly than adults. Hang in there!

      • I think she was asking about information on approximate timelines – is there any direction you can point Brooke in to find the information herself or is it that there is no – even very broadly general – pattern or is it that you just aren’t aware?

  14. Do you have any pediatrician referrals? I live in the East Bay and would like to find one that follows functional medicine but also takes insurance. Your help is greatly appreciated!!

    • Unfortunately I do not know of a pediatrician in the SF Bay Area that has a functional approach. My partner and co-director of the California Center for Functional Medicine, Dr. Schweig, is not a pediatrician but he does work with children and he’s an excellent functional medicine physician. He has a wait list but I think it’s not overly long at the moment. drschweig.com

  15. I listened attentively to Chris’s podcast about lifelong constipation, but never heard, because he never mentioned, his assessment of old fashioned natural remedies such as dried figs or prunes. I would really appreciate some mention of ‘old-fashioned’ NATURAL remedies.
    Thanks in advance, Chris !

  16. Thanks for addressing this topic! My son was born prematurely at 30 weeks and reflux is very common in preemies because the sphincter isn’t fully developed until they approach h their due date. He was on Prevacid because his reflux was complicating his apnea but once he came home and was no longer on the dairy fortified (HMF) we were quickly able to wean him off the Prevacid.
    It took a LOT of work to get him a healthy gut as he grew but with careful attention to his diet I think he now has a healthy gut. (Now 3)
    Thankfully my daughter who was also a 30 weeker did not require acid suppressing drugs.

  17. Scary article for me. My daughter was put on a PPI at 2 months because she could not take more than an ounce of formula before screaming in pain. It took awhile for the doctor to decide it was reflux, and once she was put on it, she started eating great and gaining weight like she should have been. Now at age 10 she occasionally has a touch of reflux, but usually tells me she’ll just wait it out because she doesn’t like the taste of Tums. Background: she’s adopted, so no info on birthmom’s pregnancy diet or SIBO, and no breastfeeding because we adopted her from birth. The doctor had us put her on soy formula for a time to try to resolve the issue before he decided it was reflux (a decision I deeply regret now that I know what I know about soy). Incidentally I have always wondered if there was an anatomical issue that caused it in the first place. I don’t think her diet is of concern at this time because she naturally gravitates to a paleo diet, but I still wonder what long-term issues she may have if there is an underlying issue we don’t even know exists.

    • My daughter had life threatening respiratory issues when doc’s failed to identify her problems as GERD for almost 10 years, then we did reglan and Prilosec for a while. One physician stated that this resolves as puberty for some girls-her problem completely resolved after menstruation then after a few years she had very painful stomach aches when menstruating. A very good OB/GYN doc I worked with recommended fish oil and magnesium. She is now 30 and has never had another stomach issue. God bless and keep you all as you tend to your kids-it’s truly hard to watch what they go through. For us-there was light at the end of the tunnel-may it be there for you all too!

  18. Hi Chris,
    My twin boys were born by C-section and developed colic at 16 weeks. I did combination feeding for 3 months until I just couldn’t handle any more from exhaustion and their silent reflux began at 4 months. It was a hell I can barely speak of. They didn’t sleep and were in pain, I had to physically hold them upright most of the night. Omeprazole helped finally though I had no alternative, and they were on it until just before they were 2 when they finally started sleeping and we weaned them off. The sleeplessness and stress of this all led me to develop Hashimotos and adrenal fatigue which is how I came across your site. Coincidentally this past week their reflux has come back and I felt flattened once more and couldn’t believe your post appeared.

    I’ve been restricting the acidic foods in the diet and raising their beds again which has helped loads. My question is, now they are older than 2 is there anything that can be done for their gut? I know the first two years are when the microbiome is formed so is it now too late for B. infantis? Your podcast seems aimed more at small infants, not the larger toddlers that haven’t outgrown” the reflux as the Doctors erroneously promised they would. The guilt I feel for not having given them the right start is horrible after everything I’ve learnt recently. Any advice on how to proceed would be so appreciated.
    And thank you for everything you do- you’ve been invaluable and instrumental in my own personal recovery.

    • It’s not too late for B. infantis (which is often used in adults to treat IBS), so that’s still a good choice. Prescript Assist is also a great choice for toddlers once they’re older than two years old.

      You could try a low FODMAP version of the Paleo diet, or a GAPS intro type of diet. Those are a pain, but they can be quite effective along with the probiotics.

    • Wow Amy you’ve been through a lot. I know because I’ve been through what you’ve described with only one and can’t imagine dealing with two at the same time (I’ve got Hashi too so I truly know). One note though: my daughter was exclusively breastfed but still developed reflux so severe that she stopped eating, stopped gaining weight for over a month and had Apparent Life Threatening Events (ALTEs) where she stopped breathing and turned blue – even when she was sitting upright! Her reflux got to crisis point only starting at the 3-4 month point as well. While, true, formula is known to make reflux worse the reflux in your twins may well have developed just like my daughters (who didn’t have formula but still developed severe reflux) even if you had killed yourself breastfeeding twins exclusively. Don’t feel guilty for the decisions you had to make to keep your children painfree and from failing to thrive.

      • Thank you Chris- slightly terrified by the work involved in the GAPS intro diet given in already doing the autoimmune paleo diet. But will start with paleo I think.
        Great to hear infantis will still work and I’m already taking Prescript assist so that’s easy to give them. I’ve read extensively about how setting up the microbiome is so important – birth method, breast feeding etc. all of which were somewhat out of my hands. Is it at all possible to totally reverse this damage/ totally replace the bad start over the years or is it just a case of making the best of a bad hand?
        And thank you so much Ann for your comment and kind words it means a lot. I do hope sometimes that given they were born at 36 weeks this had something to do with their prematurity even if it didnt appear until 4 months in and they had healthy birth weights.

        • just wanted to pass on that i did the GAPS intro and diet for awhile and started my baby on it at 6 months. Both my kids had reflux and I have SIBO and the kids definitely have dysbiosis likely because i had no Bifido in my guts to pass on (metametrix stool test).
          what i found , like chris has mentioned in other articles, is that GAPs is beneficial for a short time (like maybe a week for me) to heal a bit before trying to re-inoculate the gut. i return to gaps when i get food poisoning or do anything to really aggravate my SIBO. For me and my kids constipation always got worse (and blood sugar crashes too) on the GAPS diet. I found that a small amount of safe starch and lots of coconut oil is my right balance at this time. Prescript-Assist, high potency bifido capsules, potato starch, lots of fat and some safe starch has helped my kids to become regular and sleep better, although it took until my youngest was 2 to start these remedies. perhaps the ginger in the sauerkraut and other types of bitters helped too……
          we still have issues but so much better. it’s nearly impossible to pick out food intolerances and next to impossible to stick with low fodmap, dairy free, nightshade free, egg free diet as a nursing mother. i was able to go dairy free and low fodmap and that definitely helped. good luck everyone!

  19. Thanks for answering my question! Very helpful answer. I should have said I have a hard time believing that we have an epidemic of GERD requiring PPI’s, because we might actually HAVE an infant GERD epidemic on our hands with all of the predisposing factors so commonly present these days. I noticed this issue not only in the clinic, but also in my friends’ babies. One of them was on a PPI from 2-10 mos, and after she stopped the PPI, she shot up in weight, to actually be on the growth chart. She was also anemic with a Hgb of 6, which the ped could not explain. She also started having seizures after her 12 month shots. Another friend’s child was on them and got pneumonia at 2 mos, chronic ear infections, and now likely has some food allergies. What really concerns me is the fact that it seems like no adverse health outcomes ever seem to be connected to the long-term use of PPIs in infants by the pediatricians or specialists. Thanks for all you do in terms of looking at the literature, Chris. Keep it up.

  20. Had a child w/ acute gerd born in the mid 80’s. My comment is anyone that has a child having repeat URI’s, pneumonia or vomiting frequently where undigested food is identifiable should in the least find out if gerd is the problem. We went through numerous doc’s and specialists and tx for asthma-where even told it was ‘all in her head’-before an indirect laryngoscopy identified webbed tissue and ulcerations had formed in her esophagus as a result of severe reflux. As we had no other knowledge of gerd or alternatives at the time, she did take reglan and Prilosec for a few years, but by onset of puberty her symptoms disappeared. Gerd was significant enough though, to have caused several respiratory failures prior to it’s definitive diagnosis. So be sure of what you are dealing with and seek out as many medical opinions as it takes to get to the bottom of your childs difficulty. Gerd can be a much more significant problem than what an adult experiences as ‘heartburn’.

    • “Gerd can be a much more significant problem than what an adult experiences as ‘heartburn’.” I completely agree Kris!

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