Gastroesophageal reflux disease - children
Peptic esophagitis - children; Reflux esophagitis - children; GERD - children; Heartburn - chronic - children; Dyspepsia - GERD - children
Gastroesophageal reflux (GER) occurs when the stomach contents leak backwards from the stomach into the esophagus (the tube from the mouth to the stomach). This is also called reflux. GER can irritate the esophagus and cause heartburn.
Gastroesophageal reflux disease (GERD) is a long-lasting problem where reflux occurs often. It may cause more severe symptoms.
This article is about GERD in children. It is a common problem in children of all ages.
Does your baby spit up all the time? Is he crying inconsolably and you can't figure out why? Your baby may have gastroesophageal reflux. When a baby eats, food passes from their throat to their stomach through the esophagus, also called the food pipe. Once food is in the stomach, a ring of muscle prevents food from moving backwards into the esophagus. If this muscle doesn't close well, food can leak back into the esophagus. This is called gastroesophageal reflux. If the reflux is causing problems, it's called GERD. How do you know for sure that your baby has GERD? Some reflux in infants after a meal is normal. Most will have reflux during their first three months of life because the ring of muscle, or sphincter, preventing food from moving back into their esophagus hasn't toughened up yet. The time to be concerned is if your baby is fussy a lot, has a chronic cough or chronic ear infections, does not eat well, or doesn't gain as much weight as he should. When GERD lasts beyond about 18 months, your child's doctor will probably want to run some tests, including pH probes, to find out how often and how long stomach acid is in your child's esophagus, gastric emptying studies, and x-rays. So, how is GERD in infants treated? Changing how you feed your baby can go a long way toward helping his reflux. Try burping your baby after he drinks one to two ounces of formula, or after feeding on each side if you are breastfeeding. You can add a tablespoon of rice to two ounces of formula, cow's milk (for baby's 12 months or older), or pumped breast milk. Changing the size of the nipple for your baby's bottle may help. Try holding your baby upright for 20 to 30 minutes after feeding too. Avoid overfeeding and avoid exposure to tobacco smoke. For some babies, avoiding cow's milk protein may also help. If reflux is still causing problems, your baby's doctor may try medications. Most babies outgrow this problem. But rarely GERD may last into childhood, potentially causing damage to their esophagus. Your child's doctor will keep an eye on the problem and let you know if surgery to fix it is a good idea.
Causes
When we eat, food passes from the throat to the stomach through the esophagus. A ring of muscle fibers in the lower esophagus prevents swallowed food from moving back up.
When this ring of muscle does not close all the way, stomach contents can leak back into the esophagus. This is called reflux or gastroesophageal reflux.
In infants, this ring of muscles has not fully developed, and this can cause reflux. This is why babies often spit up after feeding. Reflux in infants goes away once this muscle develops, often by age 1 year.
When symptoms continue or become worse, it may be a sign of GERD.
Certain factors can lead to GERD in children, including:
- Birth defects, such as hiatal hernia, a condition in which part of the stomach extends through an opening of the diaphragm into the chest. The diaphragm is the muscle that separates the chest from the abdomen.
- Obesity.
- Certain medicines, such as some medicines used for asthma.
- Secondhand smoke.
- Surgery of the upper abdomen.
- Brain disorders, such as cerebral palsy.
- Genetics -- GERD tends to run in families.
Symptoms
Common symptoms of GERD in children and teens include:
- Nausea, bringing food back up (regurgitation), or perhaps vomiting.
- Reflux and heartburn. Younger children may not be able to pinpoint the pain as well and instead describe widespread belly or chest pain.
- Choking, chronic cough, or wheezing.
- Hiccups or burps.
- Not wanting to eat, eating only a small amount, or avoiding certain foods.
- Weight loss or not gaining weight.
- Feeling that food is stuck behind the breastbone or pain with swallowing.
- Hoarseness or a change in voice.
Exams and Tests
Your child may not need any tests if the symptoms are mild.
A test called a barium swallow or upper GI may be performed to confirm the diagnosis. In this test, your child will swallow a chalky substance to highlight the esophagus, stomach, and upper part of his small intestine. It can show if liquid is backing up from the stomach into the esophagus or if anything is blocking or narrowing these areas.
If the symptoms do not improve, or they come back after the child has been treated with medicines, the health care provider may perform a test. One test is called an upper endoscopy (EGD). The test:
- Is done with a small camera (flexible endoscope) that is inserted down the throat
- Examines the lining of the esophagus, stomach, and first part of the small intestine
The provider may also perform tests to:
- Measure how often stomach acid enters esophagus
- Measure the pressure inside the lower part of the esophagus
Treatment
Lifestyle changes can often help treat GERD successfully. They are more likely to work for children with milder symptoms or symptoms that do not occur often.
Lifestyle changes mainly include:
- Losing weight, if overweight
- Wearing clothes that are loose around the waist
- Sleeping with the head of the bed slightly raised, for children with nighttime symptoms
- Not lying down for 3 hours after eating
The following diet changes may help if a food appears to be causing symptoms:
- Avoiding food with too much sugar or foods that are very spicy
- Avoiding chocolate, peppermint, or drinks with caffeine
- Avoiding acidic drinks such as colas or orange juice
- Eating smaller meals more often throughout the day
Talk with your child's provider before limiting fats. The benefit of reducing fats in children is not as well proven. It's vital to make sure children have the proper nutrients for healthy growth.
Parents or caretakers who smoke should quit smoking. Never smoke around children. Secondhand smoke can cause GERD in children.
If your child's provider says it's OK to do so, you can give your child over-the-counter (OTC) acid suppressors. They help reduce the amount of acid produced by the stomach. These medicines work slowly, but relieve the symptoms for a longer period. They include:
- Proton pump inhibitors
- H2 blockers
Your child's provider may also suggest using antacids along with other medicines. Do not give your child any of these medicines without first checking with the provider.
If these treatment methods fail to manage symptoms, anti-reflux surgery may be an option for children with severe symptoms. For example, surgery may be considered in children who develop breathing problems.
Talk with your child's provider about what options may be best for your child.
Outlook (Prognosis)
Most children respond well to treatment and to lifestyle changes. However, many children need to continue taking medicines to control their symptoms.
Children with GERD are more likely to have problems with reflux and heartburn as adults.
Possible Complications
Complications of GERD in children may include:
- Asthma that might get worse
- Damage to the lining of the esophagus, which may cause scarring and narrowing
- Ulcer in the esophagus (rare)
When to Contact a Medical Professional
Contact your child's provider if symptoms do not improve with lifestyle changes. Also call if the child has these symptoms:
- Bleeding
- Choking (coughing, shortness of breath)
- Feeling full quickly when eating
- Frequent vomiting
- Hoarseness
- Loss of appetite
- Trouble swallowing or pain with swallowing
- Weight loss
Prevention
You can help reduce risk factors for GERD in children by taking these steps:
- Help your child stay at a healthy weight with a healthy diet and regular exercise.
- Never smoke around your child. Keep a smoke-free home and car. If you smoke, quit.
References
Khan S, Matta SKR. Gastroesophageal reflux disease. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 349.
National Institute of Diabetes and Digestive and Kidney Diseases. Acid reflux (GER & GERD) in infants.
Richards MK, Goldin AB. Neonatal gastroesophageal reflux. In: Gleason CA, Juul SE, eds. Avery's Diseases of the Newborn. 10th ed. Philadelphia, PA: Elsevier; 2018:chap 74.
Vandenplas Y. Gastroesophageal reflux. In: Wyllie R, Hyams JS, Kay M, eds. Pediatric Gastrointestinal and Liver Disease. 6th ed. Philadelphia, PA: Elsevier; 2021:chap 21.
Version Info
Last reviewed on: 7/3/2022
Reviewed by: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
