Hiatus hernia living in infants
Informed by recognized medical guidance
Overview
A hiatus hernia is a condition where part of the stomach pushes up through a small opening in the diaphragm (the muscle that helps you breathe) into the chest. In infants, this is usually a problem they are born with (congenital). It can cause stomach acid and food to flow back up into the food pipe, leading to reflux and other symptoms.
Key facts
- A hiatus hernia is often found in babies who have frequent or severe reflux.
- Most cases in infants are mild and improve as the baby grows and the diaphragm strengthens.
- Treatment focuses on managing symptoms, such as keeping the baby upright after feeds and thickening feeds if recommended by a doctor.
Hiatus hernia in infants is not very common, but it is one of the causes of gastro-oesophageal reflux in babies. Many babies with reflux do not have a hiatus hernia.
Hiatus hernia can affect infants, especially those born prematurely or with other health conditions. It is sometimes linked to other problems like a weak diaphragm.
Symptoms
- If your baby stops breathing, turns blue, or has difficulty breathing
- If your baby is vomiting blood or has blood in their stool
- If your baby is extremely lethargic or unresponsive
- ⚠If your baby is vomiting forcefully (projectile vomiting)
- ⚠If your baby shows signs of dehydration (dry mouth, fewer wet diapers, sunken eyes)
- ⚠If your baby is in severe pain or crying non-stop
Common symptoms
- Frequent spitting up (regurgitation) of milk or formula
- Vomiting
- Irritability or crying after feeds
- Arching of the back during or after feeding
- Poor weight gain or failure to thrive
Symptoms in children
- Older children may complain of heartburn or a burning feeling in the chest
- Difficulty swallowing
- Feeling full quickly or refusing to eat
Causes
Main causes
- A weakness or opening in the diaphragm that allows part of the stomach to move upward
- This is often present from birth (congenital)
Risk factors
- Premature birth
- Certain genetic conditions that affect the diaphragm
- Increased pressure in the abdomen (for example, from coughing or crying a lot)
When to see a doctor
See a doctor urgently if:
- If your baby has trouble breathing
- If your baby vomits blood or has blood in the stool
- If your baby seems dehydrated or is not feeding at all
Book a routine appointment if:
- If your baby has frequent spitting up that seems painful or affects weight gain
- If you notice your baby arching their back or refusing to eat
- If your baby is not gaining weight as expected
Diagnosis
Doctors diagnose hiatus hernia by taking a careful history of symptoms and performing tests to see the stomach and diaphragm.
Tests that may be done
- An X-ray with a special dye (barium swallow) that shows the shape of the stomach and food pipe
- An endoscopy – a thin, flexible tube with a camera is used to look inside the food pipe and stomach
- Sometimes a pH study to measure acid levels in the food pipe
What to expect at your appointment
The doctor will ask about your baby’s feeding, vomiting, and growth. Tests are usually done in a hospital or clinic. They may involve keeping your baby still for a short time. The doctor will explain the results and discuss treatment options if needed.
Treatment
Treatment for hiatus hernia in infants focuses on reducing reflux and supporting feeding and growth. Many infants improve with simple measures as they grow older.
Self-care at home
- Feed your baby in an upright position and keep them upright for at least 20–30 minutes after feeding
- Offer smaller, more frequent feeds
- Burp your baby well during and after feeds
- Thicken feeds if advised by a doctor (using thickeners like rice cereal – follow your doctor’s instructions)
Medical treatments
Doctors may recommend medicines that reduce stomach acid or help the stomach empty faster. These are given only under close medical supervision. Always talk to your doctor before giving any medicine to your baby.
When is surgery considered?
Surgery is rarely needed for infants. It may be considered if the hernia is very large, causing severe reflux, or if your baby is not growing despite medical treatment. The operation repairs the opening in the diaphragm and prevents the stomach from moving up.
Living with this condition
Caring for a baby with hiatus hernia can be challenging, but most babies improve over time. You will need to be patient with feeding and keep a close eye on your baby’s comfort and growth.
Lifestyle tips
- Keep your baby upright after feeds as much as possible
- Avoid tight nappies or clothing that puts pressure on the tummy
- Elevate the head of the cot slightly (if advised by your doctor – never place pillows or soft bedding in the cot)
Diet and exercise
Breastmilk or formula is usually fine. Your doctor may suggest thickening feeds. As your baby gets older, solid foods that are easy to digest may help. Always follow your doctor’s advice on feeding changes.
Mental health and emotional wellbeing
Caring for a baby with a health condition can be stressful. You may feel worried or exhausted. It is important to take care of your own mental health too. Talk to your partner, family, or a healthcare professional if you feel overwhelmed.
Prevention
Hiatus hernia in infants is usually present from birth and cannot be prevented. However, symptoms can often be managed well to prevent complications.
Complications
If left untreated
- Severe gastro-oesophageal reflux that causes inflammation of the food pipe (oesophagitis)
- Poor weight gain and malnutrition
- Breathing problems like pneumonia (from inhaling stomach contents)
- Anemia (low red blood cells) from slow blood loss in the food pipe
Long-term outlook
With proper care and treatment, most infants with hiatus hernia do very well. Many outgrow the condition by the time they are toddlers. Even when surgery is needed, the outlook is excellent. Your healthcare team will help you every step of the way.
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Always verify with your doctor
Health guidelines vary by country and region. The information in this article is based on international clinical guidelines but may not reflect the specific guidelines, medications, or practices in your country. Always discuss your health concerns with your own doctor or healthcare provider, and refer to your local national health guidelines where available.
Important notice This information is for educational purposes only. It does not replace professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider about your specific situation. If you are experiencing a medical emergency, call your local emergency services immediately.
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Sources and guidance
This article is educational and is prepared with reference to recognized health information and clinical guidance sources where available. Specific source links may vary by topic.
Last updated: July 20, 2026
Educational note: This information is for education only and is not a diagnosis.
Use it to support, not replace, advice from a licensed clinician.
If symptoms are severe, worsening, or urgent, call your local emergency number or seek emergency care.