What is reflux?

• Reflux is when stomach contents (food and acid) move backwards into the throat.
• Healthy children can sometimes have reflux.
• Reflux is a problem when there are symptoms that do not go away or when it contributes to other health conditions.

What are the symptoms of reflux?

• Heartburn (pain in upper abdomen or chest)
• Stomach pain
• Feeding difficulties
• Swallowing difficulty and choking
• Runny or stuffy nose
• Bad breath
• Hoarseness
• Frequent hiccups and burping
• Coughing, wheezing, difficulty breathing, frequent pneumonia

Foods that can trigger reflux:

• Some foods can increase acid production in the stomach, relax the opening between the stomach and esophagus, slow emptying of the stomach into the intestines, and irritate the lining of the digestive tract.
• Reducing intake of these foods can limit reflux symptoms:
  • High-fat foods: deep-fried foods, fast foods, high-fat nuts, butter, lard, margarine, shortening, cream sauces, creamy dressings, mayonnaise, and processed/fatty meats such as bacon, sausage, ribs, salami, hamburger
  • Spicy foods: hot sauce, pepper, curry
  • Acidic foods and drinks
    • Citrus fruits and juices, vinegar, fizzy beverages, ketchup
    • Canned and bottled foods and drinks, including baby foods (acids are added to increase shelf-life)
  • High-sugar foods and drinks: soft drinks, candy, ice cream, baked goods
  • Caffeine: coffee, tea, soda, chocolate, “energy” drinks and bars
  • Minty foods: gum, mints, mint chocolate desserts, peppermint oil
• Other common triggers include green apples, onions, garlic, nuts, bell peppers (especially green peppers), cracked pepper, tomato, cucumber, and processed meat, (such as cold cuts and bacon).
• Chewing gum and sucking on hard candy cause your child to swallow air, which causes burping.
• Food allergies can cause swelling in the lining of the esophagus. Your healthcare provider might recommend eliminating some foods, such as dairy, wheat, soy, egg, nuts, and fish. It is important to work with your healthcare provider to make sure the diet meets your child’s needs.

Other factors that contribute to reflux:

• Constipation
• Lying down soon after eating
• Overweight or obesity
• Stress
• Low magnesium
• Curved spine (scoliosis)
• Chronic lung disease
• Weak muscles (hypotonia)
• Small intestinal bacterial overgrowth (SIBO)

Healthy eating when reflux is a concern:

• The ideal diet pattern to reduce reflux includes low-acid foods that are low in fat and sugar, and foods that are high in fiber.
• Healthy fats are an important part of your child’s diet. Use added fats in small amounts, spread through the day in meals and snacks.
• An Anti-Inflammatory Diet is recommended for children who have reflux symptoms. Tell your healthcare provider if you would like to know more about this diet pattern.
• It is important to drink plenty of water to prevent constipation and promote food moving through the digestive tract.
• Cooked foods may be better tolerated than raw foods.

Foods that tend to not trigger reflux include:

• Fruits: apple, banana, melon, ripe pear, papaya, and pineapple
• Vegetables: baked potatoes, carrots, broccoli, green beans, peas, and asparagus
• Grains: cooked whole grains (brown rice, oatmeal, quinoa, millet, farro), whole grain baked goods, whole grain bread/crackers/cereals/pasta, popcorn without butter
• Protein: skinless chicken, turkey, and fish (grilled/broiled/baked/steamed), tofu, lentils, beans
• Milk and milk products: cow’s milk, plain yogurt, fortified soy/hemp/oat/coconut/nut milks
• Fats: avocado, olive oil, walnuts, flaxseed, and sunflower oil
• Herbs and spices: ginger, lemon balm, chamomile, caraway
• Beverages: water, mineral water, decaffeinated tea (chamomile, ginger) chicken broth, aloe vera juice (bottled without citric acid)

Once reflux symptoms have resolved, try adding a wider variety of fruits, vegetables, and healthy fats to the diet. Start with small portions. You might be able to add raw foods and increase spices.

Flavoring ideas that avoid spice and acid:

• Salty: miso, soy sauce, salt, capers, anchovies, grated cheese
• Tangy/acidic: citrus zest, yogurt, Dijon mustard, vinaigrette
• Savory: toasted sesame seed, tahini, caraway seed, dried mushrooms, fish sauce, clam juice, strained chicken stock, olive oil, avocado, toasted nuts, egg, butter
• Zing: ginger, cinnamon, cardamom, cloves, lemongrass, coriander, nutmeg
• Fresh: herbs – basil, oregano, parsley, dill, cilantro, thyme, rosemary, sage, lemon balm
• Sweet: honey, maple syrup, agave, brown sugar, bay leaf, vanilla, dried fruit
• Bitter: spinach, broccoli, bitter greens like arugula, radishes

Timing food and drinks to limit reflux:

• Eat small meals more often. Follow a regular schedule each day, and avoid constant snacking.
• Limit or avoid eating and drinking (except water) for at least 1½ to 2 hours before bedtime.
• Drink beverages 30 minutes before or 60 minutes after meals, mainly in the morning and afternoon.
• Avoid caffeine or have a small amount in the morning.
• Sit up or take a walk after meals. Avoid intense exercise after eating or drinking.

Additional resources

• Food as Medicine podcast
• Integrative Medicine - Primary Care Perspectives Podcast