Is Your Child Dealing with Gastroesophageal Reflux Disease? Here's What You Need to Know.
Gastroesophageal reflux disease (GERD) is a condition that affects the digestive system. It occurs when the stomach contents, which are acidic, flow back up into the esophagus, which is the tube that connects the mouth to the stomach. This can cause symptoms such as heartburn, vomiting, coughing, and breathing problems. GERD can also damage the lining of the esophagus and increase the risk of esophageal cancer.
GERD is common in babies under 2 years old, but most of them outgrow it by the time they are 12 to 14 months old. GERD can also affect older children and teens, especially if they are overweight, have certain medical conditions, or take certain medications.
How frequent is GERD in children?
About 65% of babies have some degree of reflux in their first 3 months of life, but only 1% of them have GERD. The frequency of GERD decreases as babies grow older and their digestive system matures.
At the same time about 2% to 8% of bigger children and teens have GERD. The frequency of GERD increases with age and peaks in adolescence.
How to diagnose GERD in children?
The diagnosis of GERD in children is based on the history of symptoms, physical examination, and sometimes tests. The tests may include:
- pH probe. A thin tube with a sensor is inserted through the nose into the esophagus to measure the acidity level for 24 hours.
- Upper gastrointestinal (GI) series. A series of X-rays are taken after the child drinks a liquid that coats the esophagus, stomach, and small intestine.
- Endoscopy. A thin tube with a camera and a light is inserted through the mouth into the esophagus to look for inflammation, ulcers, or other abnormalities.
- Biopsy. A small sample of tissue is taken from the esophagus during endoscopy and examined under a microscope.
- Esophageal impedance. A thin tube with electrodes is inserted through the nose into the esophagus to measure how often and how long the reflux occurs.
How to treat GERD in children?
The treatment of GERD in children depends on the severity of symptoms, the age of the child, and the response to previous treatments. The treatment options may include:
- Lifestyle changes. These include avoiding foods that trigger reflux, such as chocolate, peppermint, citrus, tomatoes, spicy foods, and fatty foods; eating smaller and more frequent meals; elevating the head of the bed; avoiding lying down after eating; losing weight if overweight; and avoiding exposure to secondhand smoke.
- Medications. These include antacids, which neutralize stomach acid; H2 blockers, which reduce acid production; and proton pump inhibitors (PPIs), which block acid secretion. These medications are usually given for a short period of time and under medical supervision.
- Surgery. This is reserved for children who have severe or complicated GERD that does not respond to medications or causes serious complications, such as bleeding, narrowing, or Barrett's esophagus (a precancerous condition). The most common surgery for GERD is called fundoplication, which involves wrapping the upper part of the stomach around the lower part of the esophagus to strengthen the lower esophageal sphincter.
When is surgery indicated for GERD in children?
Surgery for GERD in children is indicated when:
- The child has severe or life-threatening symptoms that interfere with growth, development, or quality of life
- The child has complications from GERD, such as esophagitis (inflammation of the esophagus), stricture (narrowing of the esophagus), bleeding, anemia (low blood count), or Barrett's esophagus
- The child does not respond to or cannot tolerate medical therapy
- The child has other conditions that increase the risk of GERD or make it harder to treat, such as hiatal hernia (a condition where part of the stomach pushes up into the chest), neurological disorders (such as cerebral palsy or muscular dystrophy), or congenital anomalies (such as tracheoesophageal fistula or esophageal atresia)
What is the prognosis of GERD in children?
The prognosis of GERD in children varies depending on the severity of symptoms, the response to treatment, and the presence of complications. Most children with mild to moderate GERD improve with lifestyle changes and medications, and do not have long-term consequences. Some children with severe or chronic GERD may require surgery or long-term medication use, and may have complications such as esophageal damage, poor growth, respiratory problems, or dental erosion. Rarely, children with GERD may develop esophageal cancer later in life.
How can I tell if my child has GERD?
The signs and symptoms of GERD in children may vary depending on the age of the child and the severity of the condition. Some common signs and symptoms include:
- Frequent spitting up or vomiting, especially after meals
- Refusal to eat or difficulty feeding
- Poor weight gain or growth failure
- Irritability or crying during or after feeding
- Recurrent cough, wheeze, or chest infection
- Hoarseness or sore throat
- Bad breath or sour taste in the mouth
- Difficulty swallowing or pain when swallowing
- Heartburn or chest pain
How can I prevent GERD in my child?
You can help prevent GERD in your child by following these tips:
- Breastfeed your baby for at least 6 months, if possible
- Avoid overfeeding your baby or child, and burp them frequently
- Keep your baby or child upright for at least 30 minutes after feeding
- Avoid giving your baby or child foods or drinks that trigger reflux, such as chocolate, peppermint, citrus, tomatoes, spicy foods, and fatty foods
- Avoid giving your baby or child caffeine, carbonated drinks, alcohol, or tobacco
- Encourage your child to eat smaller and more frequent meals
- Elevate the head of your child's bed
- Avoid letting your child lie down or exercise right after eating
- Help your child lose weight if he or she is overweight
- Avoid exposing your child to secondhand smoke
If you notice any of these signs or symptoms in your child, you should consult your doctor for evaluation and treatment.
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