GERD in Infants and Children
Gastroesophageal reflux disease (GERD) occurs when the lower esophageal sphincter (LES) does not close properly and stomach contents leak back, or reflux, into the esophagus. The LES is a ring of muscle at the bottom of the esophagus that acts like a valve between the esophagus and stomach. The esophagus carries food from the mouth to the stomach.
When refluxed stomach acid touches the lining of the esophagus, it causes a burning sensation in the chest or throat called heartburn. The fluid may even be tasted in the back of the mouth, and this is called acid indigestion. Occasional heartburn is common but does not necessarily mean one has gastroesophageal reflux disease. Heartburn that occurs more than twice a week may be considered gastroesophageal reflux disease (GERD).
The main symptoms are persistent heartburn and acid regurgitation. Some people have gastroesophageal reflux disease (GERD) without heartburn. Instead, they experience pain in the chest, hoarseness in the morning, or trouble swallowing. You may feel like you have food stuck in your throat or like you are choking or your throat is tight.
Gastroesophageal reflux disease (GERD) can also cause a dry cough and bad breath.
Gastroesophageal reflux disease (GERD) in Children Studies* show that gastroesophageal reflux disease is common and may be overlooked in infants and children. Acid reflux is a normal process that occurs in healthy infants, children, and adults. Most episodes are brief and do not cause bothersome symptoms or problems.
However, some people with acid reflux have troublesome symptoms, including heartburn, vomiting, or pain with swallowing. In this case, the problem is called gastroesophageal reflux disease (GERD). Treatments for GERD are available and can help to reduce symptoms.
This article discusses the symptoms, causes, diagnosis, and treatment of children and adolescents with gastroesophageal reflux disease. Gastroesophageal reflux in infants and adults is discussed separately.
Children’s immature digestive systems are usually to blame, and most infants grow out of gastroesophageal reflux disease (GERD) by the time they are 1 year old. Still, you should talk to your child’s doctor if the problem occurs regularly and causes discomfort. Your doctor may recommend simple strategies for avoiding reflux, like burping the infant several times during feeding or keeping the infant in an upright position for 30 minutes after feeding. If your child is older, the doctor may recommend avoiding sodas that contain caffeine, chocolate and peppermint, spicy foods like pizza, acidic foods like oranges and tomatoes and fried and fatty foods. [Jung AD. Gastroesophageal reflux in infants and children. American Family Physician. 2001;64(11):1853 - V1860.]
Avoiding food 2 to 3 hours before bed may also help. The doctor may recommend that the child sleep with head raised. If these changes do not work, the doctor may prescribe medicine for your child. In rare cases, a child may need surgery. What causes gastroesophageal reflux disease? No one knows why people get gastroesophageal reflux disease. A hiatal hernia may contribute. A hiatal hernia occurs when the upper part of the stomach is above the diaphragm, the muscle wall that separates the stomach from the chest. The diaphragm helps the LES keep acid from coming up into the esophagus.
When a hiatal hernia is present, it is easier for the acid to come up. In this way, a hiatal hernia can cause reflux. A hiatal hernia can happen in people of any age; many otherwise healthy people over 50 have a small one.
Other factors that may contribute to gastroesophageal reflux disease include alcohol use, overweight, pregnancy and smoking
Heartburn and acid indigestion can be pretty painful at times. If it’s difficult for you to imagine the pain and discomfort for yourself, try to grasp the concept that it’s not so uncommon for infants and young children to experience as well. It’s normal for a baby to spit up sometimes throughout the day, but it should be monitored and if it’s associated with other symptoms you child could be suffering from GERD.
Acid reflux in young children and infants is caused in the same way as in adults. It’s the act of the stomach’s contents backing into their throats and mouths. The same malfunction of the lower esophageal sphincter (LES) is responsible, and usually it’s because of an infants’ immature digestive system. The good news about this is that most physicians will agree that they will grow out of it by age one. In older children it’s virtually the same as adults. Anything that causes that sphincter muscle to relax or puts undue pressure abdomen will cause this failure. You should restrict or limit your child’s intake of caffeine laden and carbonated drinks, fatty and greasy foods, and if your child is showing sings of being overweight seek guidance from your doctor on if a diet is in need.
It is fairly well known that food allergies in young children can cause gastrointestinal problems like vomiting or diarrhea, but it is less common for such food allergies to cause acid reflux. This is rare but possible side effect to food allergies.
If your infant shows signs of acid reflux you can do several things to ease her discomfort. Hold the bottle at and angle, and make sure she is not totally horizontal. Try not feed large quantities at a time, I know this is hard when they are hungry but smaller portions make it easier to digest. If she’s at a stage where she’s eating solid foods, try only one food at a time and make sure that you give it a few days before moving on, this will give you enough time to know what is causing a reaction if any. Once you know what food is causing such reaction it’s best to avoid it. This may make things a little inconvenient, but it’s worth it, and most will grow out of this stage.
ACID REFLUX SYMPTOMS
The symptoms of gastroesophageal reflux depend upon the child’s age.
Preschool - Symptoms of acid reflux in preschool-age children can include:
Vomiting or feeling stomach acid or food in the throat or mouth
Less commonly, there can be wheezing, particularly in children with asthma
Lack of interest in eating (because of pain with eating)
Weight loss
Older children and adolescents - The most common symptoms of GERD in older children and adolescents include many of the symptoms listed above, plus:
Tasting stomach acid in the throat
Nausea
Pain or burning in the upper chest (heartburn)
Discomfort or pain with swallowing
Feeling that food gets stuck while swallowing
Children who do not talk may pound their chest when they feel the heartburn. Pain usually happens after meals, may awaken the child from sleep, and may be worse with stress or when lying down. Pain can last minutes to hours.
In all age groups, constipation can cause some of the symptoms of GERD, such as upset stomach, heartburn, and nausea. Treating constipation can relieve these problems.