From Spit-Up to Strategy: Evidence-Based Guidance on Infant Reflux
Infant reflux is one of the most common concerns encountered in neonatal and perinatal care. Regurgitation, irritability, and feeding-related behaviors can prompt concern for pathology, yet current evidence confirms that most reflux in infants is a normal developmental process, not a disease requiring aggressive intervention.
The Science on Your Seat (SOYS): Infant Reflux—From Theory to Clinical Practice provides a practical, evidence-based framework to help neonatal teams distinguish physiologic gastroesophageal reflux (GER) from gastroesophageal reflux disease (GERD) and align care with current clinical guidance.
Why This Matters Nurse Leaders
Nurses and nurse leaders play a pivotal role in feeding assessments, parent education, interdisciplinary communication, and discharge planning. Variation in reflux management can lead to caregiver anxiety, inconsistent practices, and unnecessary escalation to diagnostic testing or pharmacologic therapy. The article reinforces several principles that are especially relevant to Nurse leadership:
- Most infant reflux is benign and self-limited. GER peaks in early infancy and typically resolves as the gastrointestinal tract matures.
- Symptoms are often nonspecific. Crying, arching, or visible spit-up alone do not define GERD, particularly in infants who are otherwise thriving.
- Non-pharmacologic strategies should be prioritized. Reassurance, safe positioning practices, and thoughtful feeding modifications are first-line approaches.
- Acid-suppressive medications require caution. Evidence does not support routine use in uncomplicated reflux, and these therapies carry documented risks, including increased infections—underscoring the importance of stewardship and guideline-aligned care.
Please read the full article for additional practical guidance on feeding strategies, including thickened feeds and formula modifications, with attention to viscosity, osmolality, caloric density, and safety—critical considerations for teams preparing infants and families for discharge.
About the Author
The article was authored by Mariastella Serrano, MD, Division Chief for Pediatric Gastroenterology, Hepatology and Nutrition at MedStar Georgetown University Hospital and Associate Professor of Pediatrics at Georgetown University. Board certified in Pediatrics and Pediatric Gastroenterology, Dr. Serrano has a special interest in nutritional support and inflammatory bowel disease and holds leadership roles with the Crohn’s & Colitis Foundation and the Pan American Crohn’s and Colitis Organization.
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