Many adults, at one time or another, have experienced heartburn
and an uncomfortable feeling in the chest after a big meal, or
after eating spicy foods.
When these symptoms are frequent or can't be attributed to
certain ingredients, they may be due to gastroesophageal
reflux disease (GERD). And the condition isn't just a problem
for adults, it affects kids too. In infants, GERD can cause
vomiting and fussiness after feeding. And in older kids and teens,
GERD can lead to heartburn, stomach, and chest discomfort.
Most kids outgrow GERD on their own, but some cases require
The burping, heartburn, and spitting up associated with GERD are
the result of acidic stomach contents
moving backward into the esophagus (called reflux). This
can happen because the muscle that connects the esophagus
with the stomach (the esophageal sphincter) relaxes at the wrong
time or doesn't properly close.
Many people have reflux regularly and it's not usually a
cause for concern. But with GERD, reflux occurs more often and
causes noticeable discomfort. After nearly all meals,
GERD causes heartburn, also known as acid indigestion, which
feels like a burning sensation in the chest, neck, and throat.
In babies with GERD, breast milk or formula regularly refluxes
into the esophagus, and sometimes out of the mouth. Sometimes
babies regurgitate forcefully or have "wet burps."
Most babies outgrow GERD between the time they are 1 and 2
years old. But in some cases, GERD symptoms persist. Kids
with developmental or neurological conditions, such as cerebral
palsy, are more at risk for GERD and can have more severe, lasting
Symptoms of GERD
Heartburn is the most common symptom of GERD in kids and
teens. It can last up to 2 hours and tends to be worse
after meals. In infants and young children, GERD can lead to
problems during and after feeding, including:
- frequent regurgitation or vomiting, especially after
- choking or wheezing, if the contents of the reflux get into
the windpipe and lungs
- wet burps or wet hiccups
- spitting up that continues beyond the first year of life
(when it typically stops for most babies)
- irritability or inconsolable crying after eating
- refusal to eat, at all or in limited amounts
- failure to gain weight
These symptoms may be worse if a baby lies down or is placed on
in a car seat after a meal.
Complications of GERD
Some children develop complications from GERD. The constant
reflux of stomach acid can lead to:
- breathing problems (if the stomach contents enter the
trachea, lungs, or nose)
- redness and irritation in the esophagus, a condition called
- bleeding in the esophagus
- scar tissue in the esophagus, which can make it difficult to
Because these complications can make eating painful,
GERD can interfere with proper nutrition. So if your child
isn't gaining weight as expected or is losing weight, it's
important to talk with your doctor.
In older kids, doctors usually can diagnose GERD by doing a
physical exam and hearing about the symptoms. Try to keep track
of the foods that seem to bring on symptoms in your child
- this information can help the doctor determine what's
causing the problem.
In younger children and babies, doctors might run these tests to
diagnose GERD or rule out other problems:
This is a special X-ray that can show the refluxing of liquid
into the esophagus, any irritation in the esophagus, and
abnormalities in the upper digestive tract. For the test, the
child must swallow a small amount of a chalky liquid (barium).
This liquid appears on the X-ray and shows the swallowing
24-hour pH-probe study.
This is considered the most accurate way to diagnose reflux.
A thin, flexible tube is placed through the nose into the
esophagus. The tip rests just above the esophageal sphincter to
monitor the acid levels in the esophagus. If the test finds
consistently high acid levels, it can be a sign
This series of X-ray scans tracks a special liquid as the child
swallows it. The scans can show whether the stomach is slow to
empty liquids, and whether the refluxed liquid is being inhaled
into the lungs.
In this test, doctors directly look at the esophagus, stomach,
and a portion of the small intestines using a tiny
fiberoptic camera. During the procedure, doctors may also biopsy
or take a small sample of the lining of the esophagus to rule out
other problems and determine whether GERD is causing other
Treatment for GERD depends on the type and severity of a
In babies, doctors sometimes suggest lightly thickening the
formula or breast milk with rice cereal to reduce reflux. Making
sure the baby is in a vertical position (seated or held
upright) during feedings can also help.
Older kids often get relief by avoiding foods and drinks
that seem to trigger GERD symptoms, including:
- citrus fruits
- foods with caffeine
- fatty and fried foods
- garlic and onions
- spicy foods
- tomato-based foods and sauces
Doctors may recommend raising the head of a child's bed 6 to
8 inches to minimize reflux that occurs at night. They may also try
to address other conditions that can contribute to
GERD symptoms, including obesity, alcohol consumption,
smoking, and certain medications.
If these measures don't help relieve the symptoms, the
doctor may also prescribe medication, such as H2 blockers,
which can help block the production of stomach acid, or proton
pump inhibitors, which reduce the amount of acid the stomach
In rare cases, when medical treatment alone doesn't help and
a child is failing to grow or develops other complications of
reflux, a surgical procedure called fundoplication may be an
option. The procedure involves creating a valve at the top of the
stomach by wrapping a portion of the stomach around the
When to Call the Doctor
If your child is experiencing symptoms of GERD, talk with your
doctor. With proper diagnosis and treatment, a child can get relief
from GERD symptoms and avoid longer-term health problems.
Mitchell B. Cohen, MD
Date reviewed: June 2008
Note: All information is for educational purposes only. For specific medical advice,
diagnoses, and treatment, consult your doctor.
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