Unfortunately, the current AAP recommendations regarding the ineffectiveness of the inclined supine sleeping in reducing reflux, are based on studies done with esophageal pH monitoring test. This test, developed in the 70’s, gained popularity in the mid 90’s and were used then to evaluate reflux, however, the test was subsequently discovered to be significantly flawed in evaluating reflux in infants.

The pH tests are inaccurate because they do not measure or account for nonacidic post feed reflux—the most common type of reflux in infancy. Babies reflux more after feeding, and usually, such reflux are buffered by milk and would not be reflected with pH monitoring.

In fact, the uptodate website specifically states that “these studies rarely are useful in evaluating gastroesophageal reflux (GER) or establishing the diagnosis of gastroesophageal reflux disease (GERD) in infants.”