Warm or Cold Formula for Infant Reflux? 10 Feeding Tips

| Reviewed By Sarah Schulze, MSN, APRN, CPNP

Although it is not a guaranteed solution, offering warm formula may provide some comfort to infants with reflux. This is because the warmer temperature can make it easier for babies to digest, similar to breast milk.

The way you prepare the bottle and feed your baby can have a much larger impact on reflux than temperature.

KidsHealth shares these tips:

“You don’t have to warm formula before feeding, but some babies may prefer it. It should be lukewarm (barely warm), not hot.” To warm bottles:

  • Run the bottle under very warm or hot water for a few minutes.
  • Put your baby’s bottles in a pan of hot water after removing the pan from the heat source.
  • Use bottle warmers that sit on your countertop at home or are portable.
  • Never use the microwave.

Infant reflux may be unsettling to see, but it’s actually quite common, and the issue often resolves on its own.

Formula Temperature for Reflux

Formula temperature often depends on your baby’s preference.

Many babies, both those with reflux and those who do not have it, prefer warm bottles, but some seem to do better when formula is given cool or cold.

Advantages of Warm Formula for Reflux

Warm formula is usually more comfortable for babies. Breastfed babies drink milk at body temperature, which is around 98.6 degrees Fahrenheit.

If breastfeeding isn’t an option for you, you can give your baby warm formula to mimic the feeling of breastfeeding.

Warming a bottle before use keeps the formula warmer for longer, which may help ease discomfort associated with reflux by relaxing the muscles in the esophagus and stomach.

It’s essential to note, however, that managing reflux in infants often involves multiple strategies.

Boiling tap water before mixing it with formula kills any bacteria that could be harmful to immunocompromised babies.

Just be sure to let it cool properly before using it to make bottles.

For simplicity and precision, heat your baby’s bottle with a bottle warmer (I use the Baby’s Brew warmer and absolutely love it!) instead of hot water on a stovetop or from the faucet. 

Why Some Babies Prefer Cool Formula for Reflux

Some babies like to drink cold formula because it may be soothing for their developing teeth.

Cold formula is easier to prepare, allowing your baby to get their food immediately instead of waiting for it to warm.

It’s also more convenient to bring a cold bottle around as you travel with your baby.

While some babies seem to have some relief from reflux when given cold formula, this isn’t the case for all babies.

Ideal Baby Formula Temperature

The ideal baby formula temperature is about body temperature, or 98.6 degrees Fahrenheit.

You can warm up a bottle in a programmable bottle warmer, on the stove, or under the faucet.

Microwaves may heat fluid unevenly and should not be used.

After bringing the water to the right temperature, swirl its contents to distribute the heat evenly.

You may also want to drip a little of the milk onto your wrist to test if it’s too warm.

When To See a Doctor About Your Baby’s Reflux

Gastroesophageal reflux (GER), is common among babies and often resolves on its own without medical intervention.

However, you should consult a doctor as soon as possible if you notice these signs of severe infant reflux:

  • Persistent vomiting: Your baby is frequently spitting up forcefully and seems to be in discomfort or isn’t gaining weight adequately.
  • Blood in your baby’s vomit or stool or their stools appear grainy and gritty.
  • Vomit is green, yellow, red, or brown.
  • Baby consistently refuses to feed or seems distressed during or after feeding.
  • Frequent coughing or wheezing: Reflux can sometimes lead to respiratory issues, causing coughing and wheezing.
  • Trouble breathing or experiencing choking episodes or gurgling during or after feeding.
  • Excessive irritability or discomfort.

Other severe symptoms may include:

  • Inconsolable crying from pain
  • Slow heartbeat
  • Frequent hiccuping 
A woman testing baby bottle temperature by dropping some milk on her wrist.

Understanding Infant Reflux

Reflux in infants occurs for a combination of reasons.

The primary reason is that babies have a weak lower esophageal sphincter (LES), which is the muscle between their throat and stomach.

A full stomach presses on this weak muscle and brings the food or milk back through the mouth. 

This muscle typically only opens in adults when we swallow food, but it is less developed in infants and may open randomly, particularly if an infant’s stomach is full, and allow the contents to come right back up. 

The all-liquid diet of young babies paired with the fact that they spend a lot of their time lying flat also increases the chances of spit-up.

Swallowing too quickly is also likely to cause reflux in your baby.

When Reflux Peaks and Stops in Babies

Reflux usually peaks in babies at around 4 months and stops between 12 and 18 months.

Reflux is most common from 2 to 3 weeks to about 4 to 5 months when a baby’s diet mostly consists of milk.

Starting solids may help reduce reflux, but most babies stop spitting up after feeding by their first birthday.

Consult your child’s pediatrician if your child doesn’t stop experiencing reflux after two years.

Babies who have reflux past age 2 may have GERD (gastroesophageal reflux disease). 

Difference Between Posseting and True GERD Reflux

“Posseting” refers to the mild and effortless spitting up of small amounts of milk or curdled milk after feeding. 

Babies who posset typically appear comfortable and content after spitting up and continue to gain weight normally.

Reflux, on the other hand, involves the more frequent and forceful regurgitation of larger amounts of milk or stomach contents. 

This can occur multiple times a day and might be accompanied by discomfort or pain.

Silent Reflux in Babies

Silent reflux in babies, also known as laryngopharyngeal reflux (LPR) or silent GER, is a type of reflux where stomach contents flow back up into the esophagus but without the typical visible vomiting or spitting up associated with traditional reflux.

With silent reflux, the stomach acid and partially digested food can irritate the lining of the esophagus and throat, leading to things like frequent irritability, difficulty swallowing, and poor weight gain.

Are Some Babies Predisposed to Infant Reflux?

Yes. Reflux can be more common in premature babies or those with a low birth weight. 

A family history of digestive diseases and certain neurological conditions that impair the nerves and muscles, such as cerebral palsy, can also put babies at higher risk of developing reflux.

Reflux in Bottle-Fed Versus Breastfed Babies 

Reflux can occur in both breastfed and bottle-fed babies.

However, there’s some evidence to suggest that reflux might be slightly more common in formula-fed infants.

Breast milk is easily digested and tends to empty from the stomach more quickly than formula.

Breast milk also contains antibodies that help strengthen a baby’s immune system and digestive tract, potentially reducing reflux severity.

Formulas, meanwhile, tend to be thicker or more complex than breast milk and might stay in the stomach longer.

10 Tips To Soothe & Prevent Baby Acid Reflux

Whether your child prefers warm or cold milk, help ease their tummy troubles by following these steps.

1. Keep Baby Upright Before & After Feeding

Sitting a baby upright is the proper position for feeding. You should also keep them upright for about 30 minutes after feeding.

Use this time to read a book, snuggle, or sing to your baby.

Change their diaper before feeding to keep them off their back after eating. Also, try not to put them to bed right after feeding.

2. Offer Smaller Amounts More Frequently

A full stomach puts pressure on the lower esophageal sphincter (LES), the muscle between the stomach and the esophagus, which keeps food from coming back up.

Offer smaller amounts more frequently to keep pressure off the LES and ease digestion.

3. Use a Slow-Flow Nipple

Babies spit up when they drink too much milk too quickly. Help them learn to control their milk intake by using a slow-flow nipple.

For younger babies, it also helps to use a smaller nipple.

4. Burp Baby Several Times During Feeding

Since babies take in a lot of air while feeding through a bottle, try burping your baby several times during and after a feeding. 

Burp your bottle-fed baby once after they drink about an ounce of milk and then again after they’ve finished.

5. Ask Your Pediatrician About Medications

If nothing else eases your child’s reflux, their pediatrician can help. You may want to consider medication if your child isn’t gaining enough weight.

Medications should only be a last resort and used under the guidance of your child’s doctor.

6. Ask Doctors About Adding a Thickening Agent

In place of medication, your child’s pediatrician may recommend adding rice cereal to formula to thicken it.

The heavier formula can stay in your child’s stomach longer than plain formula.

However, there isn’t enough evidence to conclude that adding cereal to the bottle eases all reflux symptoms. 

Check with your child’s pediatrician to help with your child’s specific needs.

7. Switch to a Dairy-Free Formula Brand

Some babies suffer from cow’s milk allergy (CMA), which has similar symptoms to reflux. 

Try brands designed for babies with cow’s milk protein sensitivity such as Similac Alimentum, Nutramigen, or EleCare.

8. Try Different Formula Temperatures

Experiment with formula temperatures, and observe your baby’s reaction to find the Goldilocks zone!

Carefully warm up a bottle in a programmable bottle warmer, in a pot of warm water, or under the faucet. Do not use a microwave.

If using a bottle warmer, follow the instructions to heat the prepared formula to a comfortable temperature.

Test the temperature by placing a few drops on your wrist to ensure it’s lukewarm.

Adjust if necessary by cooling the bottle slightly if it’s too warm.

Remember that the ideal baby formula temperature is 98.6 degrees Fahrenheit.  

9. Reduce Air Bubbles in the Formula

You’re normally instructed to shake the bottle to mix well or to distribute heat evenly, but even when the top bubbles have stopped frothing, air bubbles hidden in the liquid may cause painful trapped gas and reflux.

Prevent foam formation by gently pouring the water into the bottle before adding the powdered formula. Swirl or stir to blend. Don’t shake.

You could also consider using anti-colic bottles that are designed to reduce air intake during feeding.

These bottles have special venting systems to minimize the amount of air swallowed.

10. Supplement With Probiotic Powder (If You Had a C-Section)

Research at Southern Medical University has found that babies delivered by cesarean miss out on a lot of the gut-colonizing bacteria that build a strong immune system.

To compensate for losing out on mom’s microbes, baby consultant Charmain Mead recommends supplementing your little one’s formula with high-quality probiotic powder to boost digestion, which could potentially lessen reflux episodes.

Best Formula for Acid Reflux

Always talk to your child’s pediatrician before switching formulas.

The following types of infant formula are designed to alleviate digestive issues or are tailored to babies with food intolerances and special requirements.

  • Hydrolyzed protein: This formula also contains cow’s milk protein but has added ingredients to relieve digestion issues. If your child has food allergies, their pediatrician may recommend trying this for a few weeks to see if symptoms are alleviated.
  • Soy milk: Since this formula doesn’t have any cow’s milk, your child should only have it if they have an intolerance to lactose or galactose, both found in cow’s milk. Soy milk formula may affect bone development and create hormonal imbalances in young children.
  • Amino acid formula: This formula is made without the use of cow’s milk protein or soy and can provide adequate nutrition for infants who need to avoid the protein altogether. 
  • Specialized formula: Check with your child’s pediatrician about formula made especially for babies with specific medical conditions, such as premature birth.

How Modern Infant Formula May Be Impacting Reflux

Formula contains prebiotics, which are an essential food source for gut microbes. 

A 2023 review published by Frontiers in Nutrition found that recent trends involved in processing infant formula mean that temperature may affect the microbial inactivation rate. 

Essentially, this could mean that certain infant formulas are manufactured in a way that may affect your baby’s gut microbiome.

Whether this is for better or worse in terms of reflux and digestion, though, remains unclear.