GERD in Children

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What Is GERD (Gastroesophageal Reflux Disease) in Children?

GERD in Children or Acid Reflux is a long-term digestive disorder. It occurs when the stomach contents push back into the food pipe (esophagus). GERD can be present in some infants, but they outgrow the condition by 12 to 14 months of age.

Alternate names

  • Acid Reflux

Is this a medical emergency?

GERD in children is not a medical emergency in all cases.

Causes of GERD in children

GERD in children is caused due to the following reasons:

Abnormalities of the lower esophageal sphincter: The lower esophageal sphincter (LES) is a specialized ring of muscle at the lower end of the food pipe where it joins the stomach. The LES valve opens to allow the food into the stomach and closes to keep the food in the stomach. If it does not close properly or opens and closes at the wrong time, it can cause the stomach contents to push back into the food pipe, causing GERD. Other causes for GERD in children include:

  • Being obese and having pressure on the abdomen from being overweight
  • Being exposed to second-hand smoking
  • Taking certain medications like antihistamines, asthma medications, pain relievers, or antidepressants
  • Having a prior surgery of the esophagus or upper abdomen
  • Having a hiatal hernia

Risk factors for GERD in children

The risk of incidence of acid reflux in kids is increased in the following conditions:

  • Developmental abnormalities like down syndrome
  • Neurological disorders like cerebral palsy and muscular dystrophy
  • Taking certain medications like antihistamines, asthma medications, pain relievers, or antidepressants
  • Having a hiatal hernia
  • Having undergone a prior surgery of the esophagus or upper abdomen
  • Being overweight

Triggering factors

The following are the foods and drinks that can trigger acid reflux in kids:

  • Fatty foods, fried, and spicy foods
  • Citrus foods
  • Peppermint
  • Chocolate
  • Garlic and onions
  • Tomatoes and tomato sauces

Symptoms & signs of GERD in children

Signs and symptoms of GERD in children include the following:

  • Vomiting and fussiness after feeding in infants
  • Pain in the chest and upper part of the abdomen, which is called heartburn
  • Taste of food or sour taste in the mouth
  • Burping or excessive belching
  • Bloating
  • Hiccups
  • Bad breath
  • Nausea and vomiting
  • Respiratory problems
  • Difficulty swallowing
  • Decaying of tooth enamel

Investigations

The following are the investigation tests that are done for acid reflux in kids:

  • Barium swallow: Barium solution is swallowed and x-rays of the digestive system are taken. This test is done to identify any ulcers or abnormal blockages
  • Esophageal acid testing (pH monitoring): Esophageal pH monitoring measures the amount of acid backing up from the stomach into the esophagus
  • Gastric emptying studies: This study is to determine how well the food empties from the stomach into the small intestine
  • 24-hour impedance-probe study: This test detects reflux and the number of reflux episodes
  • Milk scans: This scan is done to measure the rate at which the stomach empties
  • Upper endoscopy: Endoscopy is done to visualize the inner lining of the digestive tract
  • Esophageal manometry: This test is done to identify if the child has any problems with reflux or swallowing
  • Chest x-ray: An x-ray of the chest is taken to check if stomach contents have moved into the lungs

Diagnosis of GERD in children

Diagnosis of GERD in children is made on reviewing the symptoms, physical examination findings, and results of the investigation tests.

GERD in children treatment options

Treatment of GERD in children depends upon their age, severity of the condition, and general health. In the majority of the cases, GERD is treated with lifestyle modifications and diet changes in children.

A. Medical treatment

Medications that are administrated in the treatment of GERD in children include the following:

  • H2 blockers: These medications help to block the production of stomach acid
  • Proton pump inhibitors: These medications help to reduce the amount of acid the stomach produces
  • Prokinetics: These medications help to strengthen the lower esophageal sphincter and help the stomach to empty faster
  • Antacids: Antacids give quick relief from GERD in children

B. Interventional treatment including surgery and indications for surgery/surgical treatment for acid reflux in kids

  • Tube feedings: In case if the child is premature or has a congenital heart problem, tube feedings are suggested. Milk is given through a tube that is placed in the nose through the food pipe into the stomach. Also, some tubes are placed through the nose into the small intestine bypassing the stomach.
  • Surgery: In severe cases of acid reflux in kids, a minimally invasive procedure called fundoplication is performed. This procedure is done laparoscopically. The top portion of the stomach is wrapped around the esophagus. This creates a tight band, strengthens the lower esophageal sphincter, and decreases the reflux.

C. Role of diet/exercise/lifestyle changes/preventive measures

The treatment and lifestyle changes for GERD in infants include the following:

  • After feeding, hold the baby in an upright position for 30 minutes
  • Keep the baby in a seated or upright position (vertical position) while feeding
  • Raise the head of the child's bed 6 to 8 inches
  • Thicken the formula or breast milk with rice cereal to reduce reflux
  • Burp the baby a few times during feedings

The treatment and lifestyle changes for GERD in children include the following:

  • Avoid or limit fatty and fried foods
  • Avoid peppermint and chocolates
  • Avoid drinks with caffeine, soda, tea, and citrus fruits
  • Avoid tomatoes and tomato sauces
  • Offer small portions of meals more often
  • Make sure to offer an evening meal at least 3 hours before bedtime
  • Avoid to lie down or going to bed soon after a meal
  • Avoid wearing tight-fitting clothes

Complications

Frequent episodes of acid reflux in kids or GERD in children may damage the esophagus and also lead to the following complications:

  • Ulcers
  • Esophageal strictures
  • Barrett's esophagus
  • Redness and irritation of the throat and food pipe
  • Scar tissue formation in the food pipe, causing difficulty swallowing
  • Infection of the lungs (if the stomach contents enter the lungs)
  • Asthma
  • Caugh
  • Fluid accumulation in sinuses and middle ears
  • Frequent vomiting due to GERD in children can lead to poor nutrition and poor weight gain

Prognosis

The overall prognosis of acid reflux in kids or GERD in children is good. Mild symptoms respond to non-medical measures and medications. Severe cases can be treated with surgical treatment.

When to contact the doctor/How to identify complications?

Medical consultation for acid reflux in kids is recommended if the child has persistent vomiting, difficulty swallowing, throat pain, and trouble breathing.

Indications for hospitalization if required

Hospitalization for GERD in children is required while performing tube feedings or a surgical procedure.

Suggested clinical specialists/Departments to consult for acid reflux in kids

  • Pediatrics
  • Gastroenterology and Hepatology
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