|SSM Cardinal Glennon Children's Medical Center|
At one time or another, many adults have had heartburn (an uncomfortable feeling in the chest) after eating a big meal or spicy foods.
When these symptoms happen often or aren't tied to certain ingredients, they might be due to gastroesophageal reflux (GER) — also called gastroesophageal reflux disease (GERD).
But GER isn't just a problem for adults — kids can have it, too, even babies. In infants, it can cause vomiting and fussiness after feeding. And in older kids and teens, GER can lead to heartburn, and stomach and chest discomfort.
Most kids outgrow GER over time but some will need medical treatment.
The burping, heartburn, and spitting up associated with GER are the result of acidic stomach contents moving backward into the esophagus (this is called reflux). This can happen because the muscle that connects the esophagus to the stomach (the esophageal sphincter) relaxes at the wrong time or doesn't properly close.
Many people have reflux regularly and it's not usually a cause for concern. But with GER, reflux happens more often and causes noticeable discomfort. After nearly all meals, GER causes heartburn, also known as acid indigestion, which feels like a burning sensation in the chest, neck, and throat.
In babies with GER, breast milk or formula regularly refluxes into the esophagus, and sometimes out of the mouth. Sometimes babies regurgitate forcefully or have "wet burps." Most babies outgrow GER between the time they are 1 or 2 years old.
But in some cases, GER symptoms last. Kids with developmental or neurological conditions, such as cerebral palsy, are more at risk for GER and can have more severe, lasting symptoms.
Symptoms of GER
Heartburn is the most common symptom of GER in kids and teens. It can last up to 2 hours and tends to be worse after meals. In babies and young children, GER can lead to problems during and after feeding, including:
Some of these symptoms may become worse if a baby lies down or is placed on in a car seat after a meal.
Complications of GER
Some children develop complications from GER. The constant reflux of stomach acid can lead to:
Because these complications can make eating painful, GER can interfere with proper nutrition. So if your child isn't gaining weight as expected or is losing weight, it's important to talk with your doctor.
In older kids, doctors usually diagnose GER by doing a physical exam and hearing about the symptoms. Try to keep track of the foods that seem to bring on symptoms in your child — this information can help the doctor determine what's causing the problem.
In younger children and babies, doctors might run these tests to diagnose GER or rule out other problems:
Treatment for GER depends on the type and severity of the symptoms.
In babies, doctors sometimes suggest lightly thickening the formula or breast milk with rice cereal to reduce reflux. Making sure the baby is in a vertical position (seated or held upright) during feedings can also help.
Older kids often get relief by avoiding foods and drinks that seem to trigger GER symptoms, including:
Doctors may recommend raising the head of a child's bed 6 to 8 inches to minimize reflux that happens at night. They also may try to address other conditions that can contribute to GER symptoms, including obesity and certain medicines — and in teens, smoking and alcohol use.
If these measures don't help relieve the symptoms, the doctor may also prescribe medicine, such as H2 blockers, which can help block the production of stomach acid, or proton pump inhibitors, which reduce the amount of acid the stomach produces.
Medications called prokinetics are sometimes used to reduce the number of reflux episodes by helping the lower esophageal sphincter muscle work better and the stomach empty faster.
In rare cases, when medical treatment alone doesn't help and a child is failing to grow or develops other complications, a surgical procedure called fundoplication might be an option. This involves creating a valve at the top of the stomach by wrapping a portion of the stomach around the esophagus.
When to Call the Doctor
If your child has GER symptoms, talk with your doctor. With proper diagnosis and treatment, kids can get relief and avoid longer-term health problems.
Reviewed by: J. Fernando del Rosario, MD