Reflux and GERD in Children

Gastroesophageal reflux (GER), or reflux, happens when food or stomach acid flows back from the stomach into the esophagus, the tube that carries food from the mouth to the stomach. It can cause irritation or a burning feeling. Occasional reflux is common in children, especially after big meals or exercise, and is usually not a problem.

Gastroesophageal reflux disease (GERD) is a more serious, long-lasting form that can cause repeated symptoms or damage the lining of the esophagus. Reflux two or more times a week may be a sign of it, and a provider may diagnose GERD if reflux causes pain, feeding problems or irritation of the esophagus. GERD is less common, and most symptoms improve with time and lifestyle changes.

Why it happens

A small ring of muscle, the lower esophageal sphincter, works as a valve between the esophagus and stomach. It relaxes to let swallowed food through and otherwise stays closed. Together with the diaphragm, the large muscle between chest and abdomen, it usually keeps stomach contents down. In children with GERD, the sphincter may be weak or relax when it should not, because of:

• a hiatal hernia, in which the top of the stomach pushes up into the chest;
• extra pressure on the abdomen from overweight or obesity;
• certain medicines, such as some for asthma, allergies, depression or pain;
• smoking or secondhand smoke;
• earlier surgery on the esophagus or upper abdomen;
• developmental delays or neurological conditions such as cerebral palsy;
• lung conditions such as cystic fibrosis.

Symptoms

Symptoms vary with age. Some children never notice reflux; others taste food or acid at the back of the mouth. GERD can cause:

• heartburn, a burning feeling in the chest or throat, more common in older children and teens;
• bad breath;
• nausea or vomiting;
• trouble or pain swallowing;
• cough, hoarseness or breathing problems;
• tooth enamel worn away by acid.

Other conditions can cause similar symptoms. See your child's provider if symptoms are frequent or interfere with eating, sleep or daily activities.

Diagnosis

Usually a provider can tell from the symptoms and health history. Tests are needed only if symptoms do not improve with lifestyle changes or medicine, or if another problem is suspected:

• Upper GI series: the child swallows barium, a chalky liquid (mixed into a bottle or food for young children), and x-rays track it through the esophagus and stomach.
• Esophageal pH and impedance monitoring: a thin tube passed through the nose measures when and how much acid or liquid comes up, recorded over 24 hours, sometimes in the hospital.
• Upper GI endoscopy and biopsy: a flexible tube with a light and camera looks at the esophagus, stomach and first part of the small intestine, and tissue samples may be taken.

Treatment

Simple changes often help:

• maintaining a healthy weight;
• eating smaller meals;
• avoiding high-fat or other trigger foods;
• wearing clothes that are loose around the belly;
• staying upright for 3 hours after meals and not slouching;
• raising the head of the bed 6 to 8 inches.

If that is not enough, a provider may recommend medicine that lowers the amount of acid the stomach makes; some are sold over the counter and some need a prescription. Do not give your child any medicine unless the provider recommends it. For severe or persistent symptoms, the provider may refer your child to a pediatric specialist in digestive problems, and in rare cases surgery is considered.

Untreated GERD can inflame or scar the esophagus, change its lining (Barrett's esophagus), or worsen breathing problems such as asthma.

Sources

• MedlinePlus, National Library of Medicine: "Reflux in Children," drawing on the National Institute of Diabetes and Digestive and Kidney Diseases.