About Gastroesophageal Reflux Disease (GERD) in Children

Overview

Gastroesophageal reflux disease (GERD) in children is a condition where the stomach contents flow back into the esophagus, causing troublesome symptoms and possible complications. It happens when stomach (gastric) acid moves backwards into the esophagus, leading to a variety of symptoms that can interfere with daily life.

GERD can happen in infants and children of all ages and is more than just harmless regurgitation (food or liquid coming back up into the mouth without vomiting). The lower esophageal sphincter (LES), which normally prevents the backflow of stomach contents, may not work properly in children with GERD. Symptoms of GERD in children can vary and may include heartburn, regurgitation, chronic coughing, respiratory symptoms, repeat pneumonia, and even growth issues. Diagnosis of GERD is based on symptoms, but these signs can be unclear, especially in infants. Treatment options for GERD in children typically involve lifestyle modifications, medication, and occasionally surgical intervention.

Causes and Risk Factors

Gastroesophageal reflux disease (GERD) in children can have various disease causes. Some of the common causes include:

Immature gastroesophageal junction: In infants, the area where the stomach and esophagus meet (gastroesophageal junction) isn’t fully developed. This can cause stomach contents to flow back into the esophagus, leading to reflux.
Short distance and lack of acute angle between the esophagus and the gastric fundus (angle of His): In infants, the short distance and less sharp angle between the esophagus and the upper part of the stomach (the angle of His) make it easier for stomach contents to flow back into the esophagus. This can contribute to GERD symptoms like spitting up and discomfort, because the stomach acid isn’t kept down as effectively.

Non-modifiable risk factors for GERD in children cannot be changed or controlled. These include:

Age: Infants are more prone to GERD because their digestive systems aren’t fully developed yet.
Genetic factors: Certain genetic differences may increase the risk of developing GERD.

Modifiable risk factors for GERD in children can be influenced or changed. These include:

Diet: Consuming a liquid milk-based diet, especially in infants, can worsen GERD symptoms.
Positioning: Lying down after feeding can make GERD symptoms worse because it allows stomach contents to flow back into the esophagus more easily.
Lifestyle factors: Overfeeding, consuming large meals, and eating close to bedtime can increase the risk of GERD symptoms.

It's important to note that these risk factors may vary from child to child. Consult with a healthcare professional for personalized advice and treatment options.

Symptoms

The most common early symptoms of gastroesophageal reflux disease (GERD) in children include:

Heartburn: A painful, burning feeling in the middle of the chest, behind the breastbone, rising from the lower tip of the breastbone toward the throat. This symptom is more common in older children and teens.
Regurgitation: Stomach contents coming back up through the esophagus and into the throat or mouth, which may cause a child to taste food or stomach acid.
Vomiting: It may occur along with regurgitation.

As GERD progresses or becomes more severe in children, other common symptoms that may occur include:

Nausea
Chest pain or upper abdominal pain
Problems swallowing or pain while swallowing
Symptoms of complications in the mouth, throat, or lungs, such as cough, hoarseness, or wheezing

It's important to note that not all children with GERD will experience heartburn or regurgitation. If your child is experiencing any symptoms suggestive of GERD, it's best to consult with a healthcare professional for an accurate diagnosis and appropriate management.

Diagnosis

To diagnose gastroesophageal reflux disease (GERD) in children, doctors commonly perform the following examinations, tests, and procedures:

Review of symptoms and medical history: Doctors assess the child's symptoms and medical history to determine if they match with GERD.
Upper GI series: This test examines the shape of the child's upper gastrointestinal tract. The child drinks a contrast liquid called barium, which helps visualize the esophagus and stomach using x-rays.
Esophageal pH and impedance monitoring: This procedure measures the amount of acid or liquid in the child's esophagus. A thin flexible tube is inserted through the child's nose into the stomach to monitor reflux activity.

To determine the stage or severity of GERD in children, additional examinations, tests, and procedures may include:

Endoscopy: This procedure involves inserting a thin, flexible tube with a camera into the child's esophagus to visually examine the lining for any problems or inflammation.
24-hour pH-study: This test monitors the child's esophageal pH levels over a 24-hour period to assess acid reflux patterns.
Scintigraphy of the esophageal-gastric tract: This imaging test uses a special substance with a traceable marker (radio nuclide-labeled substance) to track the movement of food and liquid through the esophagus and stomach.

It's important to note that these tests are typically performed when lifestyle changes and medications do not improve symptoms. Always consult with a healthcare professional for accurate diagnosis and appropriate testing.

Treatment Options

The goals of treatment for gastroesophageal reflux disease (GERD) in children are to relieve symptoms, reduce the frequency and severity of reflux episodes, heal any damage to the esophagus, and improve overall quality of life.

Here are different treatment options and how they work:

Medication types:

Antacids: Neutralize stomach acid to provide temporary relief.
Histamine receptor antagonists: Reduce the production of stomach acid.
Proton pump inhibitors (PPIs): Block the production of stomach acid more effectively than histamine receptor antagonists.

Medical procedures:

Endoscopic procedures: Used to treat complications like esophagitis (inflammation of the esophagus) and strictures (narrowing)
Surgical interventions: Nissen fundoplication is a common procedure that wraps the top of the stomach around the lower esophageal sphincter to prevent reflux.

Health behavior changes:

Feeding changes: Smaller, more frequent meals; thickening formula or breast milk
Avoiding trigger foods: Certain foods can worsen reflux symptoms, such as spicy or fatty foods, citrus fruits, and carbonated beverages.
Positioning: Keeping the child upright for at least 30 minutes after feeding
Elevating the head of the bed: Placing blocks under the bed legs to raise the head of the bed can help prevent nighttime reflux.
Weight management: Maintaining a healthy weight can reduce symptoms

Other treatments:

Complementary and alternative therapies: Some patients may seek alternative therapies like herbal remedies or acupuncture, but their effectiveness is not well-established.

It's important to note that treatment approaches may vary depending on the severity of GERD and the child's individual needs. Always consult with a healthcare professional for personalized advice.

Medication dosing may be affected by many factors. Check with your health care professional about dosing for your individual situation. Other side effects can occur. Check with your health care professional or read the information provided with your medication for additional side effect information.