Most infants occasionally spit up throughout the day. However, when it causes other problems or is associated with other symptoms it may be due to gastroesophageal reflux disease (GERD), which can also occur in older children.

What Are the Symptoms of Acid Reflux in Infants and Children?

The most common symptoms are:

• Frequent or recurrent vomiting.
• Frequent or persistent cough.
• Refusing to eat or difficulty eating (choking or gagging with feeding).
• Crying with feeding.
• Heartburn, gas, or abdominal pain.

Many other symptoms are sometimes blamed on gastroesophageal reflux, but much of the time, we really aren’t sure whether reflux actually causes them. Other problems seen in young children and infants that may be blamed on gastroesophageal reflux include:

• Colic
• Poor growth
• Breathing problems
• Recurrent pneumonia

What Causes GERD and Acid Reflux in Infants and Children?

Like in adults with the condition, gastroesophageal reflux is the upward movement of stomach contents into the esophagus and sometimes into or out of the mouth.

Usually the infants with the condition are otherwise healthy, but some babies have other problems affecting their nerves, brain, or muscles. According to the National Digestive Disease Information Clearinghouse, a child’s immature digestive system is usually to blame. They add that most infants grow out of GERD by the time they are 1 year old.

In older children, the causes of GERD are often the same as those seen in adults. Anything that causes the muscular valve between the stomach and esophagus (the lower esophageal sphincter or LES) to relax, or anything that increases the pressure below the LES, can cause GERD. Such things include obesity, overeating, and certain foods, beverages, and medications.

Will My Baby Outgrow Acid Reflux?

Yes. Most babies outgrow infantile GERD. However, reflux can also occur in older children. In either case, the problem is usually easily managed.

How Is Acid Reflux Diagnosed in Infants and Children?

Usually, the medical history as told by the parent is enough for the doctor to make a diagnosis of acid reflux, especially if the problem occurs regularly and causes discomfort; but occasionally, further tests are recommended. They may include:

• Barium swallow or upper GI series. This is a special X-ray test that uses barium to highlight the esophagus, stomach, and upper part of the small intestine. This test may identify any obstructions or narrowing in these areas.

pH probe. During the test, the patient is asked to swallow a long, thin tube with a probe at the tip that will stay in the esophagus for 24 hours. The tip is positioned, usually at the lower part of the esophagus, and measures levels of stomach acids. It also helps determine if breathing problems are the result of reflux.
Upper GI endoscopy. This is done using an endoscope (a thin, flexible, lighted tube and camera) that allows the doctor to look directly inside the esophagus, stomach, and upper part of the small intestine.
Gastric emptying study. During this test, the child drinks milk or eats food mixed with a radioactive chemical. This chemical is followed through the gastrointestinal tract using a special camera. Some patients with GERD have a slow emptying of the stomach that may be contributing to the reflux of acid.

What Are the Treatments for Acid Reflux in Infants and Children?

There are a variety of lifestyle measures you can try for acid reflux in your child:

For infants:

• Elevating the head of the baby’s crib or bassinet.
• Holding the baby upright for 30 minutes after a feeding.
• Thickening bottle feedings with cereal (do not do this without a doctor’s supervision).
• Changing feeding schedules.
• Trying solid food (with your doctor’s approval).

For older children:

• Elevating the head of the child’s bed.
• Keeping the child upright for at least two hours after eating.
• Serving several small meals throughout the day, rather than three large meals.
• Limiting foods and beverages that seem to worsen your child’s reflux.
• Encouraging your child to get regular exercise.

If the reflux is severe or doesn’t get better, your doctor may recommend medicines to treat the reflux.

Medications to Lessen Gas

• Mylicon
• Gaviscon

Medications to Neutralize or Decrease Stomach Acid

Antacids such as Mylanta and Maalox

• Histamine-2 (H2) blockers such as Axid, Pepcid, Tagamet, or Zantac
• Proton-pump inhibitors such as Nexium, Prilosec, Prevacid, Aciphex, and Protonix.

Researchers aren’t sure whether decreasing stomach acid lessens reflux in infants.

For the most part, medicines that decrease intestinal gas or neutralize stomach acid (antacids) are very safe. At high doses, antacids can cause some side effects, such as diarrhea. Chronic use of very high doses of Maalox or Mylanta may be associated with an increased risk of rickets (thinning of the bones).

Side effects from medications that inhibit the production of stomach acid are quite uncommon. A small number of children may develop some sleepiness when they take Zantac, Pepcid, Axid, or Tagamet.

Medications to Improve Intestinal Coordination

• Propulsid. This drug was voluntarily withdrawn from the U.S. market in 2000; however, it is still available with very limited access. The drug works by increasing the pressure of the lower esophageal sphincter and increasing emptying of the stomach and the rate that food moves through the intestines. This helps reduce esophageal exposure to stomach contents. The drug is very effective for treating childhood reflux. However, the drug is associated with abnormal heart rhythms.
• Reglan. This is another medication that helps speed up the digestion process. However, it is also associated with many side effects, some of which can be serious.
• Erythromycin. This is an antibiotic usually used to treat bacterial infections. One common side effect of erythromycin is that it causes strong stomach contractions. This side effect is advantageous when the drug is used to treat reflux.

Surgery for Reflux in Children

Surgery isn’t often needed to treat GERD in children. When it is necessary, the Nissen fundoplication is the most often performed surgery. During this procedure, the top part of the stomach is wrapped around the esophagus forming a cuff that contracts and closes off the esophagus whenever the stomach contracts - preventing reflux.

The procedure is usually effective, but it is not without risk. Discuss the potential risks and benefits of this operation with your child’s doctor.

Tags: GERD and Acid Reflux in Infants and Children

This entry was posted on Monday, June 30th, 2008 at 12:27 pm and is filed under Acid reflux. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.