Gastroesophageal Reflux Disease (GERD)

Gastroesophageal reflux disease (GERD) is a common problem evaluated at GI Care for Kids. GERD is a frequent concern in infants and children with respiratory diseases, neurological problems, feeding disorders, and otherwise healthy children. In many cases, GERD causes mild symptoms but in some children, GERD can cause significant complications like esophagitis or breathing problems. The best treatment is different for each child.

General information:

Gastroesophageal reflux (GER) is when stomach contents come up into the esophagus (the tube that connects the mouth to the stomach), during or after a meal. In infancy this occurs frequently. It can result in spitting, irritability, vomiting, or coughing. Usually, the infant is otherwise healthy, happy and growing well. The older child might also complain of heartburn, regurgitation or frequent swallowing. Gastroesophageal reflux disease (GERD) occurs when the reflux of food or liquid causes problems with feeding, growing, or breathing.

There are many reasons why infants have GER. The lower esophageal sphincter (LES) is the gate to the stomach at the end of the esophagus. In infants, reflux occurs when the LES relaxes at inappropriate times. These episodes of LES relaxation occur less often as infants get older. Reflux of stomach contents into the esophagus also may occur when infants eat, cry or strain. Less commonly, reflux can occur as a result of abnormal anatomy, inflammation caused by the stomach acid, allergy, or a problem of another body system.

How is the Diagnosis of GER or GERD made?

The healthcare provider may be able to determine that an infant or child has GER by talking with the family about the child symptoms, and by doing a physical exam. Depending upon your child's symptoms, tests may be used as well.

These may include:

Upper GI/Barium series - A test where your child is given barium to drink, to assess the flow of food through the esophagus and stomach. It looks for abnormal anatomy or blockages. It is not usually done to look for reflux, as reflux can be present in children and not cause them any problems.

24 hour pH probe - A test where a small tube is inserted through the child's nose down to the esophagus, to measure the acid refluxing up from the stomach over a 12 to 24 hour period.

Upper Endoscopy - A test performed while your child is asleep. A small tube is inserted through the mouth and down into the stomach and small intestine. The doctor can see if the lining looks irritated. Small pieces of tissue are biopsied. These are looked at under a microscope to help determine if GER has caused inflammation.

Scintiscan / Gastric Emptying Scan - A test where the child is given a drink or meal with a small amount of dye in it. It looks for the presence of reflux, and how well the stomach empties. It can also help to determine if stomach contents get into the lungs.

How is GER or GERD treated?

The treatment for GER and GERD is dependent upon your child's symptoms and age. Most infants will outgrow GER by the age of 18 months. So long as the child is growing, healthy and happy, the treatment is usually limited to some of those suggestions below.

For Infants:

  • Elevate the head of the crib or bed about 30 degrees.
  • If the baby is bottle fed, add up to one tablespoon of rice cereal to 2 ounces of infant milk (includes expressed breast milk). This may be too thick for your infant to easily take through the nipple.
  • Experiment with the nipple size, cross cut the nipple, or vary the amount of cereal added to a desirable thickness.
  • Burp your baby after they have ingested 1 or 2 ounces of formula, or for breastfed infants, after they have completed feeding on one side.
  • Do not overfeed your infant. Discuss the amounts of formula / breastmilk which are appropriate for your child's size, with your doctor.
  • When possible, hold your infant upright in your arms for 30 minutes after feeding.
  • Discuss sleep positioning with your doctor, as some infants may need to be placed on their sides or stomach when they have GER.

For the older child:

  • Have them avoid eating 2-3 hours before going to bed.
  • Elevate the head of the bed 30 degrees, and consider placing the child (over the age of 3) on a second pillow.
  • Have them avoid carbonated drinks, chocolate, caffeine, and foods that are high in fat, or contain a lot of acid (citrus), or spices.

Medications:

  • H2 Receptor antagonists
  • Proton pump inhibitors

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