Gastroesophageal Reflux Disease in Children

Gastroesophageal Reflux Disease in Children

Gastroesophageal reflux disease (GERD) happens when acid from the stomach flows up into the tube that connects the mouth and the stomach (esophagus).

When acid comes in contact with the esophagus, the acid causes soreness (inflammation) in the esophagus. Over time, GERD may create small holes (ulcers) in the lining of the esophagus.

Some babies have a condition that is called gastroesophageal reflux. This is different than GERD. Babies who have reflux typically spit up liquid that is made mostly of saliva and stomach acid. Reflux may also cause your baby to spit up breast milk, formula, or food shortly after a feeding. Reflux is common in babies who are younger than two years old, and it usually gets better with age. Most babies stop having reflux by age 12–14 months. Vomiting and poor feeding that lasts longer than 12–14 months may be symptoms of GERD.

What are the causes?

This condition is caused by abnormalities of the muscle that is between the esophagus and stomach (lower esophageal sphincter,LES). In some cases, the cause may not be known.

What increases the risk?

This condition is more likely to develop in:

• Children who have cerebral palsy and other neurodevelopmental disorders.
• Children who were born before the 37th week of pregnancy (premature).
• Children who have diabetes.
• Children who take certain medicines.
• Children who have connective tissue disorders.
• Children who have a hiatal hernia. This is the bulging of the upper part of the stomach into the chest.
• Children who have an increased body weight.

What are the signs or symptoms?

Symptoms of this condition in babies include:

• Vomiting or spitting up (regurgitating) food.
• Having trouble breathing.
• Irritability or crying.
• Not growing or developing as expected for the child’s age (failure to thrive).
• Arching the back, often during feeding or right after feeding.
• Refusing to eat.

Symptoms of this condition in children include:

• Burning pain in the chest or abdomen.
• Trouble swallowing.
• Sore throat.
• Long-lasting (chronic) cough.
• Chest tightness, shortness of breath, or wheezing.
• An upset or bloated stomach.
• Bleeding.
• Weight loss.
• Bad breath.
• Ear pain.
• Teeth that are not healthy.

How is this diagnosed?

This condition is diagnosed based on your child’s medical history and physical exam along with your child’s response to treatment. To rule out other possible conditions, tests may also be done with your child, including:

• X-rays.
• Examining his or her stomach and esophagus with a small camera (endoscopy).
• Measuring the acidity level in the esophagus.
• Measuring how much pressure is on the esophagus.

How is this treated?

Treatment for this condition may vary depending on the severity of your child’s symptoms and his or her age. If your child has mild GERD, or if your child is a baby, his or her health care provider may recommend dietary and lifestyle changes. If your child’s GERD is more severe, treatment may include medicines. If your child’s GERD does not respond to treatment, surgery may be needed.

Follow these instructions at home:

For Babies

If your child is a baby, follow instructions from your child’s health care provider about any dietary or lifestyle changes. These may include:

• Burping your child more frequently.
• Having your child sit up for 30 minutes after feeding or as told by your child’s health care provider.
• Feeding your child formula or breast milk that has been thickened.
• Giving your child smaller feedings more often.

For Children

If your child is older, follow instructions from his or her health care provider about any lifestyle or dietary changes for your child.

Lifestyle changes for your child may include:

• Eating smaller meals more often.
• Having the head of his or her bed raised (elevated), if he or she has GERD at night. Ask your child’s healthcare provider about the safest way to do this.
• Avoiding eating late meals.
• Avoiding lying down right after he or she eats.
• Avoiding exercising right after he or she eats.

Dietary changes may include avoiding:

• Coffee and tea (with or without caffeine).
• Energy drinks and sports drinks.
• Carbonated drinks or sodas.
• Chocolate or cocoa.
• Peppermint and mint flavorings.
• Garlic and onions.
• Spicy and acidic foods, including peppers, chili powder, curry powder, vinegar, hot sauces, and barbecue sauce.
• Citrus fruit juices and citrus fruits, such as oranges, lemons, or limes.
• Tomato-based foods, such as red sauce, chili, salsa, and pizza with red sauce.
• Fried and fatty foods, such as donuts, french fries, potato chips, and high-fat dressings.
• High-fat meats, such as hot dogs and fatty cuts of red and white meats, such as rib eye steak, sausage, ham, and bacon.

General instructions for babies and children

• Avoid exposing your child to tobacco smoke.
• Give over-the-counter and prescription medicines only as told by your child’s health care provider. Avoid giving your child medicines like ibuprofen or other NSAIDs unless told to do so by your child’s health care provider. Do notgive your child aspirin because of the association with Reye syndrome.
• Help your child to eat a healthy diet and lose weight, if he or she is overweight. Talk with your child’s health care provider about the best way to do this.
• Have your child wear loose-fitting clothing. Avoid having your child wear anything tight around his or her waist that causes pressure on the abdomen.
• Keep all follow-up visits as told by your child’s health care provider. This is important.

Contact a health care provider if:

• Your child has new symptoms.
• Your child’s symptoms do not improve with treatment or they get worse.
• Your child has weight loss or poor weight gain.
• Your child has difficult or painful swallowing.
• Your child has decreased appetite or refuses to eat.
• Your child has diarrhea.
• Your child has constipation.
• Your child develops new breathing problems, such as hoarseness, wheezing, or a chronic cough.

Get help right away if:

• Your child has pain in his or her arms, neck, jaw, teeth, or back.
• Your child’s pain gets worse or it lasts longer.
• Your child develops nausea, vomiting, or sweating.
• Your child develops shortness of breath.
• Your child faints.
• Your child vomits and the vomit is green, yellow, or black, or it looks like blood or coffee grounds.
• Your child’s stool is red, bloody, or black.