Gastroesophageal reflux (GER) is the back up of acid or food from the stomach to the esophagus. The esophagus is the tube that connects the mouth and stomach. GER is common in infants. It may cause them to spit up. Most infants outgrow GER within 12 months.
GER that progresses to esophageal injury and other symptoms is called gastroesophageal reflux disease (GERD). The backed-up acid irritates the lining of the esophagus. It causes heartburn, a pain in the stomach and chest. GERD requires treatment to avoid complications.
GERD can occur at any age. Children with disabilities are at greater risk for these conditions.
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The lower esophageal sphincter (LES) is a muscular ring between the esophagus and the stomach. It relaxes to let food pass into the stomach then, closes shut to prevent it from backing up. With GERD, the ring doesn't close as tightly as it normally should. This causes acid reflux, a burning sensation that can be felt below the breastbone.
The following factors contribute to GERD:
- Problems with the nerves that control the LES
- Problems with LES muscle tone
- Impaired peristalsis—muscular contractions that propel food toward the stomach
- Abnormal pressure on the LES
- Increased relaxation of the LES
- Increased pressure within the abdomen
Factors that may increase your child’s chance of GERD include:
GERD may cause:
- Chronic heartburn—most common symptom
- Difficulty swallowing or choking with feedings
- Impaired breathing during sleep
- Refusal to eat
- Increased mouth secretions
- Regurgitation or vomiting
- Bloody vomit
- Weight loss or poor weight gain
- Frequent respiratory problems
- Coughing or wheezing
- Arching back while feeding
- Irritability or restlessness while feeding
You will be asked about your child's symptoms and medical history. A physical exam will be done. Your child may need to see a pediatric gastroenterologist. This type of doctor focuses on diseases of the stomach and intestines.
Images may need to be taken of your child's stomach and esophagus. This can be done with:
Other tests may include:
- 24-hour pH monitoring—a probe is placed in the esophagus to keep track of the acid in the lower esophagus
- Short trial of medications—success or failure of medication may help your doctor understand the cause
There are 3 goals for treatment. The first is to prevent injury to the esophagus. The second is to make sure your child is eating enough. The third goal is to keep the backed up food and acid from getting into the lungs. This will require a team approach. Your child may work with the pediatrician, specialized doctors, and a variety of therapists.
Talk with the doctor about the best treatment plan for your child. Treatment options include:
Most GERD in children can be relieved with lifestyle changes. Medication may be given if your child's GERD doesn't improve. Medications can help to decrease acid in the stomach and help the esophagus heal. Medication options may include:
- H-2 blockers
- Proton pump inhibitors
Many of these are over-the-counter medications that are available in liquid or powder form.
Surgery or endoscopy may be recommended with more severe cases.
The most common surgery is called fundoplication . During this procedure, a part of the stomach will be wrapped around the stomach valve. This makes the valve stronger. It should prevent stomach acid from backing up into the esophagus. This surgery is often done through small incisions in the skin.
GI Kids—North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition http://www.gikids.org
National Institute of Diabetes and Digestive and Kidney Diseases http://www.niddk.nih.gov
Canadian Digestive Health Foundation http://www.cdhf.ca
About Kids Health—The Hospital for Sick Children http://www.aboutkidshealth.ca
Gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD) in children and adolescents. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/ger-and-gerd-in-children-and-adolescents/Pages/facts.aspx. Accessed March 19, 2018.
Gastroesophageal reflux disease in infants. EBSCO DynaMed website. Available at: https://www.dynamed.com/topics/dmp~AN~T116575/Gastroesophageal-reflux-disease-GERD-in-infants . Updated April 21, 2016. Accessed March 19, 2018.
Pediatric GE reflux clinical practice guidelines. J Pediatr Gastroenterol Nutr. 2001;32:S1-S31.
- Reviewer: EBSCO Medical Review Board Kari Kassir, MD
- Review Date: 03/2018
- Update Date: 05/05/2014