Gastroesophageal reflux (GERD) is the upward movement of the stomach’s contents, including acid, into the esophagus and sometimes into or out of the mouth. GERD is also referred to as acid reflux. Most infants occasionally spit up after a meal, but frequent vomiting among infants might be caused by gastroesophageal reflux. Older children also can be affected by gastroesophageal reflux.
What are the symptoms of GERD in infants and children?
The most common symptoms are:
- Frequent or recurrent vomiting
- Frequent or persistent cough
- Heartburn, gas, abdominal pain, or colicky behavior
- Regurgitation and re-swallowing
Other symptoms are sometimes blamed on gastroesophageal reflux. In many cases, however, it is not clear whether reflux actually causes the symptoms. In young infants and children, some problems that might be blamed on gastroesophageal reflux include:
- Colic
- Feeding problems
- Recurrent choking or gagging
- Poor growth
- Breathing problems
- Recurrent wheezing
- Recurrent pneumonia
What causes GERD in infants and children?
Most of the time, reflux in infants is due the incoordination of the gastrointestinal tract. Many infants with the condition are otherwise healthy. However, some infants can have problems affecting their nerves, brain, or muscles.
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 be the cause of GERD. Factors that can play such a role include obesity, overeating, certain foods, some beverages, and specific medicines. There also appears to be an inherited component to GERD, as it is more common in some families than in others.
Will my baby outgrow infantile GERD?
Yes. Most babies outgrow infantile GERD. However, reflux can occur in older children. In either case, the problem usually can be managed easily.
How is GERD in infants and children diagnosed?
Usually, parents provide enough details for the doctor to make a diagnosis. Sometimes, however, further tests are recommended. They 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 might identify certain problems such as any obstructions or narrowing in these areas. It is not a highly sensitive or specific test for reflux.
- PH probe— This is currently considered to be the best test to diagnose reflux, but it does not always manage to detect the disease. During this test, a thin tube with a probe at the tip is placed through the nose into the esophagus. The tip, usually positioned at the lower part of the esophagus, measures levels of stomach acids. The frequency of reflux is monitored over a prolonged period of time, usually 24 hours.
- Upper GI endoscopy —This procedure uses an endoscope (a thin, flexible, lighted tube) that allows the doctor to look directly inside the esophagus, stomach, and upper part of the small intestine. Pinch biopsies (samples of tissue) of the esophagus obtained at the time of endoscopy might determine the presence of reflux.
- 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.
What are the treatments for acid reflux in infants and children?
There are a variety of lifestyle measures you can try:
For infants:
- Elevate the head of the baby's crib or bassinet.
- Hold the baby upright for 30 minutes after a feeding.
- Thicken bottle feedings with cereal. (Do not do this without a doctor's supervision.)
- Change feeding schedules.
- Try solid food.
For older children:
- Elevate the head of the child’s bed.
- Keep the child upright for at least two hours after eating.
- Serve several small meals throughout the day, rather than two or three large meals.
- Limit foods and beverages that seem to worsen your child’s reflux. These foods typically include acid-containing foods, caffeinated beverages, citrus products, tomato products, chocolate, and licorice.
- Encourage your child to get regular exercise.
- Avoid non-steroidal or aspirin-containing medicines.
If the reflux is severe or doesn't get better, your doctor might recommend medicines to treat the reflux.
Medicines for GERD
Medicines to lessen gas include antacids that contain simethicone (such as Mylicon). Medicines to neutralize or decrease stomach acid include:
- Antacids such as Mylanta and Maalox
- Acid blockers such as Pepcid, Tagamet, or Zantac
- Proton-pump inhibitors (PPIs)—These products reduce the production of acid by blocking the enzyme in the wall of the stomach that produces acid. PPIs include the brand names Axid, Nexium, Prevacid, and Prilosec
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 or constipation. Chronic use of very high doses of antacids might be associated with an increased risk of rickets (thinning of the bones).
Serious side effects from medicines that inhibit the production of stomach acid are uncommon. A small number of children might develop some sleepiness when they take Zantac, Pepcid, Axid, or Tagamet. There are other side effects of PPIs and H2 blockers. (These are drugs that block histamine2. Histamines signal the stomach to make acids.) These side effects include abdominal pain, diarrhea, nausea, vomiting, headaches, and laboratory abnormalities. As with any medicines, there are a number of additional rare side effects.
Medicines to improve intestinal coordination
- Reglan
- Erythromycin
- Propulsid
Reglan (metoclopramide) is a medicine that increases the pressure of the LES and helps speed up the digestion process. However, it is associated with many side effects, some of which can be serious. Reglan also can be associated with a number of drug interactions and might increase the risk of seizures in patients who have seizures.
Erythromycin is an antibiotic. It is 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. However, the side effect is not lasting. Erythromycin has not been shown to be effective in the long term for treatment of GERD.
Propulsid (cisapride) was voluntarily withdrawn from the U.S. market in 2000. However, it is still available with extremely limited access. The drug works by increasing the pressure of the lower esophageal sphincter (LES) and increasing emptying of the stomach and the rate that food moves through the intestines. The drug is very effective for treating childhood reflux. However, the drug was associated with abnormal heart rhythms.
Surgery for GERD
Surgery is not often used 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 lower esophagus. This procedure forms a cuff that contracts and closes off the esophagus when the stomach contracts, preventing reflux. In some patients, a pyloroplasty to improve gastric emptying might be performed at the same time. A pyloroplasty is a surgical procedure in which the lower portion of the stomach, the pylorus, is cut and re-sutured to relax the muscle and widen the opening into the intestine. The Nissen fundoplication procedure is usually effective, but it is not without risk. Discuss the potential risks and benefits of this operation with your child's doctor.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 11/1/2004
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