GERD in Children

GERD or gastroesophageal reflux disease in children is a chronic (long-term) digestive problem. It occurs when the stomach contents reflux or flow back up into the esophagus (food pipe) and causes problems or symptoms.

It is common for babies or infants to spit up after a meal, and this spitting is known as gastroesophageal reflux or GER.  GERD is a more severe and longer-lasting type of GER. The differences between the two conditions are marked by the severity and by the lasting effects. Both GERD and GER can cause reflux of stomach contents, including acid into the esophagus and sometimes up into the mouth. But difficulty feeding, weight loss, and frequent vomiting associated with discomfort may be caused by GERD. GER does not cause any major problems in babies or infants. In most cases it is outgrown by the time they are 12 to 14 months old. Older children and teens can also have GERD.

Causes

Usually, gastroesophageal reflux in babies occurs as a result of a poorly coordinated gastrointestinal tract. As per the National Digestive Diseases Information Clearinghouse, a child's immature digestive system is normally the reason, and most infants outgrow this condition by 1 to 2 years old.

GERD in children is due to a weak lower esophageal sphincter (LES) which is a muscular ring that connects the lower part of the esophagus to the stomach. The function of the LES is to prevent the upward movement of the stomach contents into the esophagus. When the sphincter is weak, it fails to close tightly enough, resulting in reflux.

Certain factors may also play a part in GERD, including overeating, obesity, eating fried or spicy foods, carbonated drinks, caffeine products, and specific medications.

Signs and Symptoms

Common symptoms of GERD in infants and children include:

• Frequent vomiting
• Frequent wheezing or coughing
• Being fussy at mealtimes
• Gagging or choking with feedings
• Breathing problems
• Trouble swallowing
• Asthma symptoms
• Belching or burping
• Stomach pain
• Having hiccups
• Developing a sour taste in the mouth
• Heartburn (a burning or painful feeling in the chest)

Diagnosis

Usually, the symptoms and medical history as given by the parent are sufficient for the doctor to diagnose if the child has GERD, particularly if the problem occurs on a regular basis and causes discomfort. The diet history and growth chart are also useful, but sometimes, additional tests are recommended and may include:

• PH study: During this study, a long, thin, flexible tube with a probe at the tip is passed through the nose into the esophagus. The tip lies just above the esophageal sphincter for 24 hours to check acid levels in the esophagus and to detect any reflux. It also helps to determine if breathing problems are due to GERD.
• Gastric empty study: Some children with GERD have a slow emptying of the stomach that may be contributing to reflux of stomach contents. During this study, your child consumes food or milk mixed with a radioactive material. A series of X-ray scans are taken which track the radioactive material as the child swallows it. These scans can show whether the stomach is slow to empty food or liquid, and whether the refluxed food or liquid is being inhaled into the lungs.
• Upper GI Endoscopy: This test checks if the digestive tract is functioning properly. The test is performed utilizing an endoscope (a thin, flexible, lighted tube fitted with a camera) that enables the physician to view directly inside the esophagus, stomach, and upper part of the small intestine, to assess functionality.
• Esophageal manometry. This test measures the strength of the esophagus muscles. A thin tube is passed through the mouth or nose into the esophagus to evaluate the pressure within the esophagus and the lower esophageal sphincter.

Treatment

Treatment for GERD in children will depend upon your child’s age, symptoms, general health, and the severity of the condition.

For babies:

• Burp your baby a few times during breast or bottle feeding. Your child may reflux more often when burping with a full stomach.
• After feedings, hold your baby in an upright position for 30 minutes.
• If bottle feeding, keep the nipple filled with milk. This way your baby will not take in excess air during eating. Choose nipples that let your baby's mouth make a good seal while feeding.
• Thicken bottle feedings with cereal with your doctor’s approval.

For children:

• Keep your child upright for at least 2 hours after eating.
• Observe your child's food intake. Limit chocolate, caffeinated drinks such as tea and sodas, fatty and fried foods, peppermint, juices, citrus fruits, and tomato products.
• Elevate the head of your child's bed.
• Serve several small meals throughout the day, rather than 3 large meals.
• Ensure your child is not overeating. If your child is overweight, contact your child’s physician to set weight loss goals.

If the GERD is severe or does not get better, your child’s doctor may recommend medication to help reduce the level of acid produced in the stomach. These medications include:

• Antacids
• Proton pump inhibitors that block acid, such as Prevacid, Prilosec, and Nexium
• Histamine-2 blockers that decrease acid in the stomach, such as Pepcid

Surgery:

Surgery is not required to treat gastroesophageal reflux in babies and children. However, for children with severe cases of reflux not responsive to medications, a surgery called fundoplication may be performed.

During this surgery, the top portion of the stomach is wrapped around the esophagus forming a cuff that contracts and closes off the esophagus whenever the stomach contracts, thereby preventing reflux.

Summary

GERD in children, if left untreated, can cause serious complications such as bleeding, perforation, ulcer, or scarring in the mucosal lining of the esophagus. Contact your doctor as soon as possible if you notice GERD-like symptoms. With timely intervention and medical guidance, you can successfully treat GERD symptoms in babies and children.