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Gastroesophageal reflux disease - children

Peptic esophagitis - children; Reflux esophagitis - children; GERD - children; Heartburn - chronic - children; Dyspepsia - GERD - children

Gastroesophageal reflux (GER) occurs when the stomach contents leak backwards from the stomach into the esophagus (the tube from the mouth to the stomach). This is also called reflux. GER can irritate the esophagus and cause heartburn.

Gastroesophageal reflux disease (GERD) is a long-lasting problem where reflux occurs often. It may cause more severe symptoms.

This article is about GERD in children. It is a common problem in children of all ages.

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Causes

When we eat, food passes from the throat to the stomach through the esophagus. A ring of muscle fibers in the lower esophagus prevents swallowed food from moving back up.

When this ring of muscle does not close all the way, stomach contents can leak back into the esophagus. This is called reflux or gastroesophageal reflux.

In infants, this ring of muscles has not fully developed, and this can cause reflux. This is why babies often spit up after feeding. Reflux in infants goes away once this muscle develops, often by age 1 year.

When symptoms continue or become worse, it may be a sign of GERD.

Certain factors can lead to GERD in children, including:

Symptoms

Common symptoms of GERD in children and teens include:

Exams and Tests

Your child may not need any tests if the symptoms are mild.

A test called a barium swallow or upper GI may be performed to confirm the diagnosis. In this test, your child will swallow a chalky substance to highlight the esophagus, stomach, and upper part of his small intestine. It can show if liquid is backing up from the stomach into the esophagus or if anything is blocking or narrowing these areas.

If the symptoms do not improve, or they come back after the child has been treated with medicines, the health care provider may perform a test. One test is called an upper endoscopy (EGD). The test:

The provider may also perform tests to:

Treatment

Lifestyle changes can often help treat GERD successfully. They are more likely to work for children with milder symptoms or symptoms that do not occur often.

Lifestyle changes mainly include:

The following diet changes may help if a food appears to be causing symptoms:

Talk with your child's provider before limiting fats. The benefit of reducing fats in children is not as well proven. It's vital to make sure children have the proper nutrients for healthy growth.

Parents or caretakers who smoke should quit smoking. Never smoke around children. Secondhand smoke can cause GERD in children.

If your child's provider says it's OK to do so, you can give your child over-the-counter (OTC) acid suppressors. They help reduce the amount of acid produced by the stomach. These medicines work slowly, but relieve the symptoms for a longer period. They include:

Your child's provider may also suggest using antacids along with other medicines. Do not give your child any of these medicines without first checking with the provider.

If these treatment methods fail to manage symptoms, anti-reflux surgery may be an option for children with severe symptoms. For example, surgery may be considered in children who develop breathing problems.

Talk with your child's provider about what options may be best for your child.

Outlook (Prognosis)

Most children respond well to treatment and to lifestyle changes. However, many children need to continue taking medicines to control their symptoms.

Children with GERD are more likely to have problems with reflux and heartburn as adults.

Possible Complications

Complications of GERD in children may include:

When to Contact a Medical Professional

Call your child's provider if symptoms do not improve with lifestyle changes. Also call if the child has these symptoms:

Prevention

You can help reduce risk factors for GERD in children by taking these steps:

References

Khan S, Matta SKR. Gastroesophageal reflux disease. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 349.

National Institute of Diabetes and Digestive and Kidney Diseases. Acid reflux (GER & GERD) in infants. www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-infants. Updated April, 2015. Accessed October 14, 2020.

Richards MK, Goldin AB. Neonatal gastroesophageal reflux. In: Gleason CA, Juul SE, eds. Avery's Diseases of the Newborn. 10th ed. Philadelphia, PA: Elsevier; 2018:chap 74.

Vandenplas Y. Gastroesophageal reflux. In: Wyllie R, Hyams JS, Kay M, eds. Pediatric Gastrointestinal and Liver Disease. 6th ed. Philadelphia, PA: Elsevier; 2021:chap 21.

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Review Date: 7/22/2020  

Reviewed By: Charles I. Schwartz, MD, FAAP, Clinical Assistant Professor of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, General Pediatrician at PennCare for Kids, Phoenixville, PA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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