Gastroesophageal reflux disease (GERD) in infants or children

Babies often spit up after eating. This small amount of sputum is called gastroesophageal reflux. But frequent vomiting associated with discomfort and difficulty eating or weight loss could be caused by something more serious, known as GERD. Gastroesophageal reflux disease and GERD can cause stomach contents, including acid, to move up into the esophagus and sometimes into or out of the mouth. Often this vomiting is repeated. The differences between the two conditions are marked by severity and long-term effects.

Older children can also have GERD.

What causes GERD in infants and children?

In most cases, reflux in children occurs due to a lack of coordination of the gastrointestinal tract. Many infants with GERD are otherwise healthy; however, some babies may have nerve, brain, or muscle problems. The child's immature digestive system is usually to blame, and most babies develop it by their first birthday.

In older children, the causes of GERD are often the same as in adults. In addition, an older child is at increased risk of GERD if they had it in infancy. Anything that causes the muscle valve between the stomach and esophagus to relax, or anything that increases pressure under the lower esophageal sphincter, can cause GERD.

Certain factors can also contribute to GERD, including obesity, overeating, eating spicy or fried foods, caffeine intake, soda, and certain medications. There also appears to be a hereditary component to GERD, as it is more common in some families than others.

What are the symptoms of GERD in infants and children?

The most common symptoms of gastroesophageal reflux disease in infants and children are:

Frequent or recurrent vomiting
Frequent or persistent cough or wheezing
Refusal to eat or difficulty eating (choking or gagging while suckling).
Heartburn, gas, abdominal pain or colic (frequent crying and irritability) associated with or immediately after eating
Regurgitation and re-swallowing
Complaints of bitterness in the mouth, especially in the morning

Many other symptoms are sometimes associated with GERD, but in most cases we are not sure if reflux is actually causing them. Other problems seen in young children and infants that can be attributed to the condition include:

Colic
Poor growth
Breathing problems or wheezing
Recurrent pneumonia

Do babies outgrow GERD?

Yes. Most children overcome reflux by one year of age, and less than 5% continue to have symptoms in childhood. However, GERD can also occur in older children. Either way, the problem is usually fixable.

What is GERD in infants and children?

Usually, a parent's history is enough for a doctor to make a diagnosis of GERD, especially if the problem occurs regularly and causes discomfort. A growth chart and feeding history are also helpful, but other tests are sometimes recommended. They may include:

Ingestion of barium or a series of upper gastrointestinal tract. This is a special x-ray test that uses barium to highlight the esophagus, stomach, and upper small intestine. This test may reveal any blockages or narrowing in these areas.
pH probe. During the test, your child is asked to swallow a long, thin tube with a probe on the end, which will remain in the esophagus for 24 hours. The tip is usually located in the lower part of the esophagus and measures the level of acid in the stomach. It also helps determine if breathing problems are the result of GERD.
Upper digestive endoscopy. This is done using an endoscope, which allows the doctor to look directly into the esophagus, stomach, and upper small intestine.
Gastric emptying study. Some people with GERD have slow stomach emptying, which can contribute to acid reflux. During this test, your child drinks milk or eats food mixed with a radioactive chemical. This chemical is monitored through the gastrointestinal tract using a special camera.

What are the treatments for acid reflux in infants and children?

There are many lifestyle measures you can try for acid reflux in infants and older children:

For babies:

Elevate the head of the baby's crib or bassinet.
Hold the baby upright for 30 minutes after a feeding.
Thicken bottle feedings with cereal (do not do this without your doctor's approval).
Feed your baby smaller amounts of food more often.
Try solid food (with your doctor's approval).

For older children:

Elevate the head of the child's bed.
Keep the child upright for at least two hours after eating.
Serve several small meals throughout the day, rather than three large meals.
Make sure your child is not overeating.
Limit foods and beverages that seem to worsen your child's reflux such as high fat, fried or spicy foods, carbonation, and caffeine.
Encourage your child to get regular exercise.
If the reflux is severe or doesn't get better, your doctor may recommend medication.

Surgery for GERD in Infants and Children

Surgery is not often required to treat acid reflux in infants and children. When needed, fundoplication is the most commonly performed operation. During this procedure, the top of the stomach wraps around the esophagus, forming a cuff that compresses and closes the esophagus each time the stomach contracts.

The procedure is generally effective, but not without risk. Discuss the potential risks and benefits of any surgery with your child's doctor.