Gastroesophageal Reflux In Children

WHAT YOU SHOULD KNOW:

• Gastroesophageal reflux (GER) occurs when food, liquid, or acid from your child’s stomach backs up into his esophagus. The esophagus is a tube that carries food and liquid from the mouth into the stomach after swallowing. There is a sphincter (tight band of muscle) at the end of the esophagus that opens to let food into the stomach. This sphincter then closes to keep the food, liquids, and stomach acid in the stomach. If the sphincter does not stay closed, food, liquids, and stomach acid may reflux (back up) into the esophagus. When your child has GER, he may not want to eat or drink and he may lose weight. His esophagus may swell and he may have problems swallowing. Your child may also be at higher risk of having lung or upper airway infections.
  
  
• If your child's GER is severe (very bad) he may be at risk for gastroesophageal reflux disease (GERD). Ask your child’s caregiver for more information about GERD. Tests to look at your child's esophagus and stomach may be needed to check for GER. Your child may also have tests done to check the acid in his stomach. Some children with GER will outgrow it and may not need treatment. Your child may also need medicines or surgery to treat his GER. Treatment for GER may be needed to prevent stomach acid from damaging the esophagus. Treatment may also make it easier for your child to swallow so he can get enough nutrition to grow.

CARE AGREEMENT:

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's caregivers to decide what care you want for your child.

RISKS:

• Your child may have an allergic response to the medicines used to treat his GER. He may have headaches, nausea (upset stomach), dizziness, or changes in his bowel movements. If your child’s symptoms do not improve or become worse, even with medicine, he may need surgery. During surgery, your child may bleed more than expected. After surgery, your child may have bruising or get an infection. Your child’s stomach may become swollen or bloated (full of air) after surgery. He may have swelling in his esophagus making it hard to swallow. He may also be at risk for seizures (convulsions).
  
  
• Without treatment of GER, your child may get ear, nose, throat, and lung infections more often. Stomach acid reflux may damage his vocal cords making his voice hoarse (rough). Your child may refuse to eat and drink causing him to lose weight. If your child is not eating or drinking, he may not grow. Your child may also become dehydrated (not enough body fluid) and very ill. When stomach acid backs up into your child's esophagus, it may damage the tissue lining. The lining of his esophagus may swell and make it hard to swallow. Damaged tissue may cause your child to vomit blood. Over time, the lining of his damaged esophagus may become cancer. If your infant has ALTE's, he may have an increased risk for sudden infant death syndrome (SIDS).

WHILE YOU ARE HERE:

Informed consent:

A consent form is a legal document that explains the tests, treatments, or procedures that your child may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your child's medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done to your child. Make sure all of your questions are answered.

• Medicine:
  
  
  • Acid reducers: Acid reducers work by decreasing the amount of acid your child has in his stomach.
    
    
  • Prokinetic medicine: Prokinetic medicine works to decrease the amount of time food stays in your child's stomach. When your child's stomach empties properly, he may have a decreased risk for reflux.
  
  
• Tests:
  
  
  • Endoscopy: An endoscopy is a test that uses an endoscope to see the inside of your child’s digestive tract. An endoscope is a long flexible tube with a light and camera on its end. During an endoscopy, caregivers will look for any tissue damage in your child's esophagus. Caregiver's will also look for problems with how your child’s digestive tract is working. A biopsy (tissue sample) may be taken from your child's digestive tract and sent to a lab for tests.
    
    
  • Esophageal pH monitoring: During esophageal pH monitoring the pH (acid or base levels) in your child’s esophagus is measured and recorded. Sensors are put into your child’s nose and lowered down into his esophagus. The sensors will normally be left in place for a day. This test measures how much, and how often stomach acid refluxes into your child's esophagus.
    
    
  • Multichannel intraluminal impedance: Multichannel intraluminal impedance is a test done to learn more about your child's reflux. Your child’s caregiver will put a tube with wires attached to it into your child’s nose. The tube is then lowered down into his esophagus. The wires record the movement and direction of food or acid in your child’s esophagus. The tube may also have sensors that measure the pH of your child's stomach acid.
  
  
• Antireflux surgery: Antireflux surgery may be needed if your child's GER does not improve with other treatments. Ask your child’s caregiver for more information about the following:
  
  
  • Corrective surgery: Corrective surgery may be needed to correct the function or structure of your child's digestive tract.
    
    
  • Fundoplication: During fundoplication surgery, a small part of your child's stomach is wrapped and secured around his lower esophagus. This surgery is done to keep the sphincter muscle tight enough so food and fluids do not reflux.
    
    
  • Jejunostomy tube placement: A jejunostomy tube is a feeding tube placed into your child's abdomen below his stomach. Your child can be given liquids and medicines through the tube. With a jejunostomy tube, the risk for reflux decreases. Abdominal swelling can also be decreased by letting extra abdominal air out of an open end of the tube.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

Learn more about Gastroesophageal Reflux In Children (Inpatient Care)