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Hiatal Hernia in Children

Medically reviewed by Last updated on Oct 3, 2022.

What is a hiatal hernia?

A hiatal hernia is a condition that causes part of your child's stomach to bulge through the hiatus (small opening) in his or her diaphragm. This part of the stomach may move up and down, or it may get trapped above the diaphragm. Your child may have been born with a large hiatus or with the hiatal hernia.

Hiatal Hernia

What are the types of hiatal hernia?

  • Type I (sliding hiatal hernia): A portion of the stomach slides in and out of the hiatus. This type is the most common and usually causes gastroesophageal reflux disease (GERD). GERD occurs when the esophageal sphincter does not close properly and causes acid reflux. The esophageal sphincter is the lower muscle of the esophagus.
  • Type II (paraesophageal hiatal hernia): Type II hiatal hernia forms when a part of the stomach squeezes through the hiatus and lies next to the esophagus.
  • Type III (combined): Type III hiatal hernia is a combination of a sliding and a paraesophageal hiatal hernia.
  • Type IV (complex paraesophageal hiatal hernia): The whole stomach, the small and large bowels, spleen, pancreas, or liver is pushed up into the chest.

What are the signs and symptoms of a hiatal hernia?

The most common symptom is heartburn. This usually occurs after meals. Your child may not have any signs or symptoms, or he or she may have any of the following:

  • Abdominal pain, especially in the area just above your child's navel
  • Frequent burping or hiccups
  • Vomiting or spitting up
  • Coughing or hoarseness
  • Not eating well because of fullness or bloating
  • Poor growth
  • Dark bowel movements
  • Breathing problems such as wheezing
  • Frequent lung infections such as pneumonia

How is a hiatal hernia diagnosed?

  • An upper GI series test includes x-rays of your child's esophagus, stomach, and small intestines. It is also called a barium swallow test. Your child will be given barium (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. An upper GI series can show if he or she has an ulcer, a blocked intestine, or other problems.
  • An endoscopy uses a scope to see the inside of your child's digestive tract. A scope is a long, bendable tube with a light on the end of it. A camera may be hooked to the scope to take pictures.
    Upper Endoscopy (Child)

How is a hiatal hernia treated?

Your child's hiatal hernia may go away on its own if it is diagnosed during infancy. He or she may need any of the following:

  • Medicines may be given to relieve heartburn symptoms. These medicines help to decrease or block stomach acid.
  • Surgery may be done when medicines cannot control your child's symptoms, or other problems are present. Your child's healthcare provider may also suggest surgery depending on the type of hernia your child has. Your healthcare provider can put your child's stomach back into its normal location. He or she may make the hiatus (hole) smaller and anchor your child's stomach in his or her abdomen. Fundoplication is a surgery that wraps the upper part of your child's stomach around the esophageal sphincter to strengthen it.

Treatment options

The following list of medications are in some way related to or used in the treatment of this condition.

How can I manage my child's symptoms?

The following nutrition and lifestyle changes may be recommended to relieve symptoms of heartburn:

Prevent GERD
  • Do not give your child foods that make his or her symptoms worse. These may include spicy foods, fruit juices, caffeine, chocolate, and mint.
  • Give your child several small meals during the day. Small meals give his or her stomach less food to digest.
  • Your child should not lie down or bend forward after he or she eats. Do not allow your child to eat meals 2 to 3 hours before bedtime. This will decrease his or her risk for reflux.
  • Your child should be at a healthy weight. If your child is overweight, weight loss may help relieve his or her symptoms.
  • Have your child sleep with his or her head elevated at least 6 inches. Ask your child's healthcare provider how to safely do this.

Call your local emergency number (911 in the US) if:

  • Your child has severe chest pain and sudden trouble breathing.

When should I seek immediate care?

  • Your child has severe abdominal pain.
  • Your child's bowel movements are black or bloody.
  • Your child's vomit looks like coffee grounds or has blood in it.

When should I call my child's doctor?

  • Your child's symptoms are getting worse.
  • Your child has nausea, and he or she is vomiting.
  • Your child is losing weight.
  • You have questions or concerns about your child's condition or care.

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 healthcare providers to decide what care you want for your child. 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.

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