Fact sheet: Pediatric Gastroesophageal Reflux Disease (GERD)
by Bonnie Schiedel
What is GERD?
GERD (also known as “reflux”) is a condition where the contents of the stomach (food and stomach acids) flow back up into the esophagus, the tube that connects the stomach to the mouth. This can lead to frequent “spitting up” and vomiting. Though the condition is often uncomfortable or painful, most children will not develop severe medical problems. However, if persistent, GERD can contribute to difficulty in gaining weight, aggravated asthma, inflammation of the esophagus, anemia, eroded dental enamel and malnutrition.
GERD Symptoms
Both children and adults can suffer from GERD. Some “spitting up” is quite normal with infants up to four months of age, but if it is associated with excessive crying, irritability, resistance to feeding or lack of weight gain, talk to your doctor. Preschool children with GERD have symptoms that include vomiting, resistance to eating, abdominal pain, unexplained nighttime waking, repeating bouts of pneumonia and respiratory symptoms like wheezing and chronic cough or hoarseness. Older children and teens often have symptoms similar to adults: chest and throat pain, difficulty swallowing and heartburn.
GERD causes and diagnosis
GERD occurs when a ring of muscle called the lower esophageal sphincter (LES) does not work properly. Normally the LES opens to allow swallowing, burping or vomiting, then closes immediately. In patients with GERD, the sphincter stays open or opens periodically, allowing the stomach contents to move into the esophagus. To diagnose GERD, you child’s doctor will evaluate the symptoms, and may order tests, including a barium x-ray to check the gastrointestinal system, evaluating the pH of the esophagus and doing a biopsy of the esophagus.
Treatment of GERD
Children with GERD may find relief by sleeping on their left side, with their chest elevated slightly, to help gravity keep the stomach contents down. However, sleeping position affects the incidence of SIDS, so discuss infant sleeping positions with your doctor. In older children, avoiding caffeine, chocolate and spicy foods may help too. For children older than age one or two, the doctor may prescribe an antacid, acid suppressors such as Pepcid or Zantac, or acid blockers such as Prevacid or Prilosec. Rarely, surgery to tighten the LES muscle is required.
“If a child older than two has a confirmed diagnosis of GERD -- that is, a biopsy has been used -- then the most important things parents can do is follow the doctor’s treatment for daily acid suppression and to watch for symptoms of complications, such as difficulty swallowing and hoarse voice,” notes Dr. Mark Gilger, a gastroenterologist at Texas Children’s Hospital in Houston.
Resources
For more information on GERD and children, check out these resources:
- Children Digestive Health and Nutrition Foundation
At this site, associated with the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, you can find a pediatric gastroenterologist in your area, download a coloring book, view a video, get kid-friendly information and more.
- Life on the Reflux Roller Coaster: Gastro Esophageal Reflux Disease in Infants and Children by Roni Maclean and Jean McNeil. A coping guide written by a family with a child with GERD.
