Gastroesophageal Reflux Disease (GERD) in Infants and Children
What is gastroesophageal reflux disease (GERD)?
Gastroesophageal reflux disease (GERD) is a disorder that involves the esophagus (the tube through which food travels to the stomach) and the stomach. GERD occurs when contents in the stomach (usually the stomach acid and formula) moves backwards into the esophagus.
The esophagus and stomach are separated by a type of muscular valve called a sphincter. Normally, the sphincter remains tightly closed except when food is swallowed. When food is swallowed, the sphincter opens to let food pass from the esophagus to the stomach. In patients with GERD, the sphincter does not close fully, causing the stomach contents to move back into the esophagus. The stomach acid causes a burning sensation when it is in the esophagus, also known as "heartburn." When this burning sensation occurs more frequently, the condition is called GERD.
What are some of the symptoms of GERD in children?
Symptoms of GERD in children include:
- Pain in the chest or stomach.
- Frequent small vomiting episodes.
- In infants, excessive crying, not wanting to eat.
- Other respiratory (breathing) difficulties.
- A frequent sour taste of acid, especially when lying down.
- A hoarse throat.
- A feeling of burping acid into the mouth.
- Trouble swallowing.
- A feeling that food is stuck in their throat.
- A feeling of choking that may wake the child up.
- Bad breath.
- Difficulty sleeping after eating (infants).
When does a child/infant need to be hospitalized for GERD?
GERD is usually treated on an outpatient basis. However your child will need to be hospitalized if he or she:
- Has poor weight gain or experiences a failure to thrive.
- Has cyanosis (a bluish or purplish discoloration of the skin due to deficient oxygenation of the blood) or choking spells.
- Experiences excessive irritability.
- Experiences excessive vomiting/dehydration.
What diagnostic tests will my child undergo?
- Barium swallow test: a certain solution is swallowed and then X-rays are taken.
- Upper endoscopy: a small tube is inserted into the esophagus and a camera is used to take pictures of the esophagus. Sometimes biopsies, or tissue samples, are taken as well.
- pH monitoring test: a tiny tube is placed in the esophagus to the stomach and it stays in place for 24 hours to measure the acid level in.
Note: Your child may or may not need all of these studies.
What treatments/management approaches for GERD will be considered for my child?
Approaches may include one or more of the following:
- Advice on avoiding triggers (certain types of food, changing formulas in infants) that may be causing GERD symptoms or making them worse.
- Over-the-counter medications.
- Prescription medications.
- Information on proper body positioning, e.g., maintaining an upright position after eating meals/feedings.
- Surgery (reserved as a last resort, or for when certain surgical correctable causes are identified).
When will my child be ready for discharge?
Your child will be ready for discharge when he or she:
- Shows decreased irritability.
- Is no longer having respiratory distress/choking spells.
- Is vomiting less often.
- Shows documented weight gain.
What will be the follow-up for my child after discharge from the hospital?
Your child should see his or her primary healthcare provider within one week to review symptom resolution and verify continued weight gain.
When should I call my healthcare provider?
Call your healthcare provider if your child:
- Has trouble feeding.
- Experiences increased irritability.
- Has poor weight gain.
- Experiences increased emesis (vomiting).
- Has cyanosis episodes (skin is turning blue). This is an emergency.