Pediatric Gastroesophageal Reflux Disease (GERD)

Pediatric Gastroesophageal Reflux Disease (GERD)

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What is gastroesophageal reflux (GERD)?

Gastroesophageal reflux occurs when a child’s digested or partially digested food flows back into the esophagus, causing heartburn, swallowing issues and in the case of young babies, frequent spitting up.

Expanded Overview

The esophagus carries food from the mouth to the stomach. There is a valve-type muscle called the lower esophageal sphincter that relaxes to let food pass from the esophagus into the stomach. When this valve does not function correctly, it causes food and acid to come back up into the esophagus.

What causes GERD?

Children from birth to 2 years old with reflux have an underdeveloped lower esophageal sphincter, causing stomach contents to flow back into the esophagus. In children older than 2, the lower esophageal sphincter is weak, causing frequent heartburn and indigestion.

What are the different types of GERD?

There are two types of pediatric reflux:
  • GER (gastroesophageal reflux) – another name for acid reflux. It’s common for young babies and most will outgrow it by the time they turn 1-year-old. In children older than 2, GER that occurs more than twice a week could be GERD.
  • GERD (gastroesophageal reflux disease) – a more serious and long-term type of reflux. In babies and children with GERD, the sphincter muscle is developed but weak, relaxing to allow food to flow back into the esophagus.

What are the symptoms of GERD?

Babies and toddlers (birth to 3-years old*)

The main symptom of acid reflux in babies and toddlers is spitting up. GERD can also cause additional symptoms in babies including:

  • Arching back, often after eating
  • Colic (crying for periods of three hours or more without a medical reason)
  • Coughing
  • Forceful or frequent vomiting
  • Gagging
  • Irritability
  • Poor eating
  • Poor weight gain (Failure to Thrive)
  • Refusing to eat
  • Trouble swallowing
  • Weight loss
  • Wheezing or trouble breathing

Children 3 to 12-years old

Children between the ages of 3 to 12 typically do not have GERD; however, they may experience the following symptoms:

  • Bad breath
  • Nausea
  • Pain in the chest or upper abdomen
  • Problems swallowing or painful swallowing
  • Respiratory issues
  • Vomiting
  • Wearing down of teeth

Children 2 years and older

In older children, the most common GERD symptom is regular heartburn.

How is GERD diagnosed?

Doctors use several tests to diagnose GERD. Children will certainly have their medical history rechecked and get another physical exam.Your child’s doctor may also use a combination of the following:

  • X-rays (upper GI series)
  • Esophagogastroduodenoscopy (EGD): a test in which a thin tube with a camera is inserted through your child’s mouth, passed through the esophagus into the stomach and small intestine
  • Esophageal pH probe study: a test in which a monitor is used to measure how often stomach acid enters the esophagus and how long it stays there
  • Esophageal manometry: a test during which a thin tube is inserted through your child’s nose into his stomach. It measures the strength of muscle contractions throughout the digestive tract

Not every child needs all these tests. Your physician will tell you exactly what the next steps are. Our diverse group of specialists see over 1,000 children a month, and we have the resources to diagnose and treat a range of conditions.

How is GERD treated?

Children with gastroesophageal reflux disease tend to respond well to lifestyle changes or medications, while infants with GERD usually outgrow it by their first or second birthday. Your child’s doctor may recommend the following treatments for GERD:

  • Lifestyle changes
    • Staying upright for three hours after eating
    • Elevating the head of the bed
    • Avoiding chocolate, peppermint and caffeine
    • Avoiding cigarette smoke
    • Losing weight (if overweight)
  • Medications
    • Antacids to neutralize stomach acid
    • H-2 blockers to block the amount of acid that is released in the stomach
    • Proton pump inhibitors to decrease the amount of acid produced in the stomach
  • Surgery
    • Fundoplication: a procedure to prevent stomach acid from backing up into the esophagus. During the surgery, the surgeon will wrap the upper part of the stomach around the end of the esophagus to put pressure on the lower end of the esophagus
    • Endoscopic sewing: a procedure that is done with an endoscope. Small stitches are used to tighten the sphincter muscle
    • Radiofrequency: a procedure that is done with an endoscope. Heat is used to create scar tissue to help strengthen the muscle between the stomach and the esophagus

Children’s Health is at the forefront of research into new treatments for pediatric gastrointestinal conditions including GERD.

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