brand logo

Am Fam Physician. 2023;108(6):614-616

This clinical content conforms to AAFP criteria for CME.

Author disclosure: No relevant financial relationships.

Case Scenario

A two-month-old full-term, formula-fed infant presents for the first well-child examination since the newborn period. The child’s parents are concerned because the infant spits up at least four times per day. The contents resemble curdled milk (nonbloody, nonbilious), and the spit-up is non-projectile. The infant is gaining weight and following the 75% weight curve for age. The parents report that the infant gets fussy every day around 5:00 p.m. The mother has a 10-year-old child who was prescribed antireflux medications around this age and is wondering if these medications should be prescribed for her infant.

Clinical Commentary

Gastroesophageal reflux, or the regurgitation of gastric contents, occurs in up to two-thirds of healthy infants.1 Gastroesophageal reflux begins approximately two to three weeks after birth and peaks between four and five months of age. Physiologic reasons for increased reflux in infants include an underdeveloped angle of His (the angle between the greater curvature of the stomach and esophagus), inadequate gastric accommodation, prolonged supine positioning, and a liquid diet. Symptoms usually resolve completely by one year of age.2 By one year of age, muscles in the lower esophagus strengthen, the esophagus lengthens, and esophageal and intestinal motility coordination improves. Normal developmental milestones, such as head control, sitting up, and the introduction of solid food, help improve gastroesophageal reflux symptoms. Infants who experience reflux without discomfort or other problems are sometimes referred to as “happy spitters.”

Already a member/subscriber?  Log In


From $165
  • Immediate, unlimited access to all AFP content
  • More than 130 CME credits/year
  • AAFP app access
  • Print delivery available

Issue Access

  • Immediate, unlimited access to this issue's content
  • CME credits
  • AAFP app access
  • Print delivery available
Purchase Access:  Learn More

Lown Institute Right Care Alliance is a grassroots coalition of clinicians, patients, and community members organizing to make health care institutions accountable to communities and to put patients, not profits, at the heart of health care.

This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

A collection of Lown Right Care published in AFP is available at

Continue Reading

More in AFP

More in PubMed

Copyright © 2023 by the American Academy of Family Physicians.

This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.  See permissions for copyright questions and/or permission requests.