Gastroesophageal Reflux In Children

What is gastroesophageal reflux?

• 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. 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. Some children with GER will outgrow it and may not need treatment. 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.

What causes gastroesophageal reflux?

GER often occurs when your child's lower esophageal sphincter is weak. A weak sphincter muscle relaxes more than it should. When this happens, the food and acid in your child's stomach can back up into his esophagus. GER may also occur if your child has an allergy to cow's milk or other foods. The following may also increase your child's risk for GER:

• Infants born earlier than expected may have an increased risk for swallowing problems and GER. Infants often outgrow GER by the time they are 12 months old.
  
  
• Neurological (brain) conditions such as cerebral palsy increase your child's risk for having GER. Ask your child's caregiver for more information about what conditions may lead to GER.
  
  
• Children who have asthma have a higher risk for getting GER.
  
  
• Drinks with caffeine or alcohol may increase your child's risk for GER. Caffeine is often found in coffee and colas. Alcohol is found in beer, wine, whiskey and other adult drinks.
  
  
• Smoking cigarettes or being around people who smoke often may lead to GER.

What are the signs and symptoms of gastroesophageal reflux?

With GER, your child may have no symptoms. If your child has symptoms of GER, he may have one or more of the following:

• Breathing problems: With GER, your child may have trouble breathing. He may wheeze (make a high-pitched noise) when breathing. He may also make a loud, rough noise when breathing. Some children, mostly infants, may have periods where they stop breathing when they have reflux. When your child's reflux causes him to stop breathing, it is called an apparent life-threatening event (ALTE). Ask your child's caregiver for more information about ALTE's.
  
  
• Cough and voice changes: GER may cause your child to cough often from the acid backing up into his throat. Your child's voice may also change and sound hoarse (rough) when he has GER.
  
  
• Heartburn: Heartburn is when your child has a painful, burning feeling in his chest. Heartburn often occurs after eating. The burning feeling comes from stomach contents or acid that backs up into his esophagus. Your child may have abdominal (stomach) pain and trouble sleeping. Your child may also belch often or get the hiccups with heartburn.
  
  
• Irritability: Your child may become fussy and cry often. He may begin crying for no known reason and he may be hard to calm .
  
  
• Poor feeding and growth: With GER, your child may not eat the right amounts of food to help him grow. He may be shorter or weigh less than other children his age or height. Infants with GER may arch (curve) their back when being fed, making it hard to feed them.
  
  
• Regurgitation: Regurgitation is the backing up of stomach contents into your child's throat or mouth.
  
  
• Swallowing problems: Your child may have problems swallowing food and liquids. He may feel like he has a lump in his throat. Your child may also feel pain when swallowing.
  
  
• Vomiting: Vomiting is throwing up and more commonly occurs in infants. Your child may throw up after eating. He may feel no pain or sickness when he is throwing up. When your child throws up often, you may see blood in his vomit.

How is gastroesophageal reflux diagnosed?

Your child’s caregiver will ask about your child’s symptoms and when they started. Tell your child's caregiver about your child’s medical conditions, eating habits, and activities. Your child's caregiver may ask about any family history of GER, and if any stressful events have happened lately. If your child has been vomiting, tell his caregiver how often and how much he vomits. Tell him if your child feels pain while vomiting. Also tell your child's caregiver if you have noticed blood in your child's vomit. Your child's caregiver will do a physical exam. Your child may also need blood taken from a vein in his arm for tests. Your child’s caregiver may also do any of the following 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. Caregivers 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 if your child has 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.
  
  
• Nuclear scintigraphy: During nuclear scintigraphy, pictures will be taken of your child's stomach and esophagus with a special machine. Your child will be asked to swallow food or milk formula that has radioactive liquid in it. This test may show if your child has acid or non-acid reflux. The test may also show how well his stomach empties. Your child's caregiver may also check if your child is aspirating. Aspirating occurs when liquid or food goes into your child's lungs.
  
  
• Upper gastrointestinal x-rays: During an upper gastrointestinal (GI) x-ray, pictures are taken of your child’s upper GI tract. The upper GI tract includes the esophagus, stomach and intestines (bowel). Your child may be given a chalky liquid to drink before the pictures are taken. This liquid helps your child’s stomach and intestines show up better on the x-rays. This test may show if your child has upper GI problems that are causing him to have GER. The x-rays may also show if there are problems with how his upper GI tract looks and functions.

How is gastroesophageal reflux treated?

The goal of treatment is to relieve your child's symptoms and prevent damage to his esophagus. Treatment is also done to promote healthy weight gain and growth. Your child may not need treatment for his GER if he has no symptoms. He may also need the following:

• 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.
  
  
• 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.

What can I do to help my child with GER?

• Keep a diary of your child's symptoms. Write down when your child becomes fussy and cries for no reason. Also write down when your child has trouble sleeping at night. Write down what your child is doing, or if he has just eaten when symptoms occur. Bring the diary to your child's visits with his caregiver. The diary may help your child's caregiver plan the best treatment for him.
  
  
• Feed your infant thickened or special formula. Thickening your infant's milk or milk formula may decrease how often he vomits. Rice-cereal can be added to your infant's feeding to make it thicker. Ask your child's caregiver for more information about thickening products. You may also try to feed your child hypoallergenic milk formula to decrease GER. Smaller feedings more often may also help decrease your infants GER.
  
  
• Position your infant after feedings to decrease his symptoms. After feeding your infant, keep him sitting upright for 90 minutes to decrease GER. You may also lay your infant on his stomach with his head slightly raised after he eats. Only lay your infant on his stomach while he is awake. Letting your infant sleep on his stomach may increase his risk for sudden infant death syndrome (SIDS). Laying your infant on his stomach helps decrease GER by decreasing the pressure on his stomach. The head of his can be raised by rolling blankets and placing them under his mattress. Laying your infant on his left side after eating may also help decrease his risk for reflux. Ask your caregiver for more information about positions that may decrease GER.
  
  
• Have your older child sleep on his left side with his head raised. Having your child sleep on his left side with his head raised may decrease his reflux while he sleeps. Your child may sleep better and his stomach may empty easier. The head of your child's bed can be raised by placing pillows under his mattress. You may also use bed raising blocks.
  
  
• Help your child make good food choices. If your child weighs more than he should for his height, his risk for GER increases. Spicy foods, chocolate and drinks with caffeine should be avoided. Make sure your child knows that staying away from certain foods may help him feel better. Talk to your child's caregiver about the best food choices him.
  
  
• Keep your child away from cigarette smoke. If you smoke, do not smoke around your child. Do not allow others to smoke around your child. If your child smokes, help him to stop. Smoking can worsen your child's GER and harm his heart, lungs, and blood. Talk to your child's caregiver if he needs help to stop smoking.
  
  
• Make sure your child does not drink alcohol. If your child drinks alcohol, his GER may worsen. Alcohol can also damage his brain, heart, and liver. Almost every part of your child's body can be harmed by alcohol. Talk to your child's caregiver if he drinks alcohol, and ask for information about how to help him stop.

What are the risks when my child has gastroesophageal reflux?

• With GER, your child may get ear, nose, throat, and lung infections more often. 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).
  
  

When should I call my child's caregiver?

Call your child’s caregiver if:

• Your child becomes more irritable or fussy, and does not want to eat.
  
  
• Your child becomes weak and is urinating less than what is normal for him.
  
  
• Your child is losing weight when he should not be.
  
  
• Your child has ear pain.
  
  
• Your child has more trouble swallowing than he has before, or feels new pain when he swallows.
  
  
• Your infant begins arching his back during feedings.
  
  
• You have questions or concerns about your child’s condition, treatment, or care.

When should I seek immediate help for my child?

Seek care immediately or call 911 if:

• Your child suddenly stops breathing, begins choking, or his body becomes stiff or limp.
  
  
• Your child's skin turns blue in color or very red.
  
  
• Your child suddenly has trouble breathing or is making new noises when trying to breathe.
  
  
• Your child vomits more blood than he has before or he vomits blood for the first time.
  
  
• Your child has very bad chest pain.
  
  
• Your child has very bad stomach pain and swelling.

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.

Copyright © 2011. Thomson Reuters. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

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