Pediatric gastroesophageal reflux disease (GERD)

What is pediatric gastroesophageal reflux disease (GERD)?

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.

Intermittent gastroesophageal reflux of gastric acid can normally occur in infancy 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) is 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 signs and symptoms of pediatric gastroesophageal reflux disease (GERD)?

Babies and toddlers (birth to 3-years old)

• Arching back, often after eating

• 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

• Colic

The main symptom of acid reflux in babies and toddlers is spitting up.

Children 2 years and older

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

Children 3 to 12-years old

• Bad breath

• Nausea/Vomiting

• Pain in the chest or upper abdomen

• Problems swallowing or painful swallowing

• Respiratory issues

• Wearing down of teeth

Children between the ages of 3 to 12 typically do not have GERD.

How is pediatric gastroesophageal reflux disease (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.

What are the causes of pediatric gastroesophageal reflux disease (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.

How is pediatric gastroesophageal reflux disease (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.

Lifestyle changes

• Staying upright for three hours after eating

• Elevating the head of the bed

• Avoiding chocolate, peppermint and caffeine

• Avoiding cigarette smoke

• Weight management

Medication

• 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

Fundoplication (surgery)

Surgery used for GERD patients is known as a fundoplication, which is a procedure to prevent stomach acid from backing up into the esophagus. Surgery involves wrap the upper part of the stomach around the end of the esophagus to put pressure on the lower end of the esophagus.