Causes and Risk Factors for Acid Reflux (Heartburn) in Children

Overview

Acid reflux in children happens when the contents of the stomach flow back into the esophagus— a muscular tube that connects your throat to your stomach—causing irritation and discomfort. It is also known as gastroesophageal reflux (GER) and can affect children of all ages, from infants to adolescents.

While the exact cause of acid reflux in children is not fully understood, there are several factors that can contribute to its development. Here are some potential causes of acid reflux in children:

Hiatal hernia: Hiatal hernias are more common in adults, but they can occur in children as well. A hiatal hernia is a condition where part of the stomach pushes up into the chest through the diaphragm (the muscle that helps with breathing). This can cause gastric acid to flow back into the esophagus and lead to acid reflux.
Positioning during feeding: The position in which a baby is fed can also contribute to acid reflux. When a baby is lying flat or in a horizontal position while feeding, it becomes easier for the stomach contents to flow back into the esophagus. Keeping the baby in an upright position during and after feeding, for about 20 to 30 minutes, can help reduce acid reflux.
Angle of His: The angle of His is the point where the esophagus connects to the stomach. The shape of this angle can affect whether acid flows back up into the esophagus, possibly leading to acid reflux.
Immature lower esophageal sphincter (LES): The lower esophageal sphincter is a ring of muscle at the bottom of the esophagus that opens to allow food into the stomach and closes to keep it there. In infants, this muscle may not be fully matured, especially if they are premature. When the LES is not fully developed, it may open more easily, allowing stomach contents to flow back into the esophagus and causing acid reflux.
Short or narrow esophagus: If a child has a shorter or narrower esophagus than normal, it can make it easier for stomach contents to flow back up and irritate the lining of the esophagus.
Diet: The foods a baby eats can also play a role in acid reflux. Making changes to their diet, such as avoiding certain foods, may help reduce the chances of acid reflux. If breastfeeding, changes to the mother's diet may also be beneficial.

It's important to note that occasional acid reflux is common in children, but gastroesophageal reflux disease (GERD) is less common and occurs when acid reflux happens frequently and causes irritation in the esophagus. If your child experiences frequent symptoms of acid reflux or GERD, it's best to consult with a pediatrician for proper diagnosis and treatment options tailored to their age and symptoms. Remember that this information is not intended as medical advice and should not replace consultation with a healthcare professional.

Non-modifiable Risk Factors (Risk Factors You Can't Change)

Non-modifiable risk factors for acid reflux in children cannot be changed or controlled to lower the risk of getting the condition. These include:

Age: Children are more prone to acid reflux, especially infants and young children. Their digestive system is still developing, which can contribute to reflux symptoms.
Sex assigned at birth: Studies have shown that boys may be more likely to experience acid reflux than girls. However, it's important to note that acid reflux can affect children of all genders.
Genetics: Family history plays a role in the development of acid reflux. If a child has a parent or sibling with acid reflux, they may be at a higher risk of experiencing it themselves.
Race or ethnicity: Certain racial or ethnic groups may have a higher chance of acid reflux. However, it's important to remember that acid reflux can affect individuals of all races and ethnicities.

Understanding these risk factors can help healthcare providers identify children who may be at a higher risk for developing acid reflux and provide appropriate management strategies.

Modifiable Risk Factors (Factors You May Be Able to Change)

Modifiable risk factors can be influenced or changed to lower the chance of getting acid reflux.

Certain lifestyle habits can contribute to acid reflux in children. These include:

Obesity: Being overweight or obese puts extra pressure on the stomach, which can cause stomach acid to flow back into the esophagus.
Exposure to tobacco smoke: Exposure to second hand smoke in children, or smoking among teens, can weaken the lower esophageal sphincter (LES), the muscle that normally prevents stomach acid from flowing back up into the esophagus.
Low levels of physical exercise: Lack of physical activity can contribute to weight gain and increase the risk of acid reflux.

Some medications can increase the risk of acid reflux in children. These include:

Drugs for asthma: Certain medications used to treat asthma, such as beta-agonists and corticosteroids, can relax the LES and contribute to acid reflux.
Calcium-channel blockers: These medications, commonly used to treat high blood pressure and certain heart conditions, can relax the LES and allow stomach acid to flow back into the esophagus.
Antihistamines: These medications, often used to treat allergies, can reduce saliva production, which is important for neutralizing stomach acid.
Painkillers: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and aspirin can irritate the lining of the esophagus and increase the risk of acid reflux.
Sedatives and antidepressants: Certain sedatives and antidepressants can relax the LES and contribute to acid reflux.

Certain foods and eating habits have been linked to acid reflux in children. These include:

Caffeine: Beverages like coffee, tea, soda, and energy drinks that contain caffeine can relax the LES and lead to acid reflux.
Alcohol: Consuming alcoholic beverages can irritate the lining of the esophagus and increase the risk of acid reflux.
Fatty foods: High-fat meals take longer to digest and can delay stomach emptying, increasing the likelihood of acid reflux.
Spicy foods: Spicy or heavily seasoned foods can irritate the lining of the esophagus and trigger acid reflux symptoms.
Tomatoes and tomato sauces: These acidic foods can worsen symptoms of acid reflux in some children.
Onions and garlic: These foods contain compounds that can relax the LES and contribute to acid reflux.
Eating large meals: Consuming large meals puts more pressure on the stomach, increasing the likelihood of stomach acid flowing back into the esophagus.
Lying down within 2-3 hours of eating a meal: This position makes it easier for stomach acid to flow back up into the esophagus.
Consuming chocolate, carbonated drinks, and acidic juices: These beverages can weaken the LES and increase the risk of acid reflux.

Reducing Risks

While some risk factors for acid reflux cannot be prevented, there are certain lifestyle changes that can help prevent or reduce the chances of acid reflux in children. Here are some actions that a person can take to modify their risk factors and prevent or reduce acid reflux in children:

Maintain a healthy weight: Obesity is a risk factor for acid reflux. Encouraging children to maintain a healthy weight through a balanced diet and regular physical activity can help reduce the chances of acid reflux.
Encourage healthy eating habits: Certain foods have been linked to acid reflux in children. It is important to avoid or limit the consumption of foods that may trigger an acid reflux attack, such as fatty meals, citrus fruits, tomatoes, spicy foods, and chocolate.
Avoid lying down after meals: After eating, it is recommended to avoid lying down for at least two hours. This helps prevent stomach acid from flowing back into the esophagus and causing acid reflux symptoms.
Wear loose-fitting clothing: Tight clothing around the abdomen can put pressure on the stomach and contribute to acid reflux. Encourage children to wear loose-fitting clothing to reduce this risk.
Limit or eliminate acidic drinks: Carbonated drinks and acidic juices can increase the likelihood of acid reflux in children. It is advisable to limit or eliminate the consumption of these beverages.
Encourage smaller meals: Consuming large meals can put pressure on the stomach and lead to acid reflux. Encourage children to eat smaller, more frequent meals to reduce this risk.
Modify sleeping position: Elevating the head of the bed by using blocks or wedges can help prevent acid from flowing back into the esophagus during sleep. It is recommended to raise the head between 6 and 8 inches off the bed.
Quit smoking: Passive smoking can also increase the risk of acid reflux in children. If someone in the household smokes, it is important to create a smoke-free environment for the child's well-being.

It's important to note that these lifestyle changes are general recommendations and may vary depending on each individual's specific situation. If your child experiences persistent or severe symptoms of acid reflux, it is recommended to consult a healthcare professional for further evaluation and guidance tailored to their specific needs. They can provide personalized advice and recommend appropriate treatment options if necessary.