What are reflux (GER) and GERD?
The esophagus is the tube that carries food from your mouth to your stomach. If your child has reflux, his or her stomach contents come back up into the esophagus. Another name for reflux is gastro esophageal reflux (GER). GERD stands for gastro esophageal reflux disease. It is a more serious and long-lasting type of reflux. If your child has reflux more than twice a week for a few weeks, it could be GERD.
What causes reflux and GERD in children?
There is a muscle (the lower esophageal sphincter) that acts as a valve between the esophagus and stomach. When your child swallows, this muscle relaxes to let food pass from the esophagus to the stomach. This muscle normally stays closed, so the stomach contents don’t flow back into the esophagus.
In children who have reflux and GERD, this muscle becomes weak or relaxes when it shouldn’t, and the stomach contents flow back into the esophagus. This can happen because of
- A hiatal hernia, a condition in which the upper part of your stomach pushes upward into your chest through an opening in your diaphragm
- Increased pressure on the abdomen from being overweight or having obesity
- Medicines, such as certain asthma medicines, antihistamines (which treat allergies), pain relievers, sedatives (which help put people to sleep), and antidepressants
- Smoking or exposure to secondhand smoke
- A previous surgery on the esophagus or upper abdomen
- A severe developmental delay
- Certain neurological conditions, such as cerebral palsy
How common are reflux and GERD in children?
Many children have occasional reflux. GERD is not as common; up to 25 percent of children have symptoms of GERD.
What are the symptoms of reflux and GERD in children?
Your child might not even notice reflux. But some children taste food or stomach acid at the back of the mouth.
In children, GERD can cause
- Heartburn, a painful, burning feeling in the middle of the chest. It is more common in older children (12 years and up).
- Bad breath
- Nausea and vomiting
- Problems swallowing or painful swallowing
- Breathing problems
- The wearing away of teeth
How do doctors diagnose reflux and GERD in children?
In most cases, a doctor diagnoses reflux by reviewing your child’s symptoms and medical history. If the symptoms do not get better with lifestyle changes and anti-reflux medicines, your child may need testing to check for GERD or other problems.
Several tests can help a doctor diagnose GERD. Sometimes doctors order more than one test to get a diagnosis. Commonly-used tests include
- Upper GI series, which looks at the shape of your child’s upper GI (gastrointestinal) tract. You child will drink a contrast liquid called barium. For young children, the barium is mixed in with a bottle or other food. The health care professional will take several x-rays of your child to track the barium as it goes through the esophagus and stomach.
- Esophageal pH and impedance monitoring, which measures the amount of acid or liquid in your child’s esophagus. A doctor or nurse places a thin flexible tube through your child’s nose into the stomach. The end of the tube in the esophagus measures when and how much acid comes back up into the esophagus. The other end of the tube attaches to a monitor that records the measurements. Your child will wear the tube for 24 hours. He or she may need to stay in the hospital during the test.
- Upper gastrointestinal (GI) endoscopy and biopsy, which uses an endoscope, a long, flexible tube with a light and camera at the end of it. The doctor runs the endoscope down your child’s esophagus, stomach, and first part of the small intestine. While looking at the pictures from the endoscope, the doctor may also take tissue samples (biopsy).
What lifestyle changes can help treat my child’s reflux or GERD?
Sometimes reflux and GERD in children can be treated with lifestyle changes:
- Losing weight, if needed
- Eating smaller meals
- Avoiding high-fat foods
- Wearing loose-fitting clothing around the abdomen
- Staying upright for 3 hours after meals and not reclining and slouching when sitting
- Sleeping at a slight angle. Raise the head of your child’s bed 6 to 8 inches by safely putting blocks under the bedposts.
How common is GER in children and teens?
Occasional GER is common in children and teens—ages 2 to 19—and doesn’t always mean that they have gastro esophageal reflux disease (GERD)
What is the difference between GER and GERD?
GER that occurs more than twice a week for a few weeks could be GERD. GERD can lead to more serious health problems over time. If you think your child or teen has GERD, you should take him or her to see a doctor or a pediatrician.
How common is GERD in children and teens?
Up to 25 percent of children and teens have symptoms of GERD, although GERD is more common in adults.1
What are the complications of GERD in children and teens?
Without treatment, GERD can sometimes cause serious complications over time, such as:
Esophagitis may lead to ulcerations, a sore in the lining of the esophagus.
An esophageal stricture happens when a person’s esophagus becomes too narrow. Esophageal strictures can lead to problems with swallowing.
A child or teen with GERD might breathe stomach acid into his or her lungs. The stomach acid can then irritate his or her throat and lungs, causing respiratory problems or symptoms, such as
- asthma —a long-lasting lung disease that makes a child or teen extra sensitive to things that he or she is allergic to
- chest congestion, or extra fluid in the lungs
- a dry, long-lasting cough or a sore throat
- hoarseness—the partial loss of a child or teen’s voice
- laryngitis—the swelling of a child or teen’s voice box that can lead to a short-term loss of his or her voice
- pneumonia—an infection in one or both lungs—that keeps coming back
- wheezing—a high-pitched whistling sound that happens while breathing
A pediatrician should monitor children and teens with GERD to prevent or treat long-term problems.
What are the symptoms of GER and GERD in children and teens?
If a child or teen has gastro esophageal reflux (GER), he or she may taste food or stomach acid in the back of the mouth.
Symptoms of gastro esophageal reflux disease (GERD) in children and teens can vary depending on their age. The most common symptom of GERD in children 12 years and older is regular heartburn, a painful, burning feeling in the middle of the chest, behind the breastbone, and in the middle of the abdomen. In many cases, children with GERD who are younger than 12 don’t have heartburn.
Other common GERD symptoms include
- bad breath
- pain in the chest or the upper part of the abdomen
- problems swallowing or painful swallowing
- respiratory problems
- the wearing away of teeth
What causes GER and GERD in children and teens?
GER and GERD happen when a child or teen’s lower esophageal sphincter becomes weak or relaxes when it shouldn’t, causing stomach contents to rise up into the esophagus. The lower esophageal sphincter becomes weak or relaxes due to certain things, such as
- increased pressure on the abdomen from being overweight, obese, or pregnant
- certain medicines, including
- those used to treat asthma —a long-lasting disease in the lungs that makes a child or teen extra sensitive to things that he or she is allergic to
- antihistamines—medicines that treat allergy symptoms
- sedatives—medicines that help put someone to sleep
- smoking, which is more likely with teens than younger children, or inhaling secondhand smoke
Other reasons a child or teen develops GERD include
- previous esophageal surgery
- having a severe developmental delay or neurological condition, such as cerebral palsy
When should doctor’s help?
Call a doctor right away if your child or teen
- vomits large amounts
- has regular projectile, or forceful, vomiting
- vomits fluid that is
- green or yellow
- looks like coffee grounds
- contains blood
- has problems breathing after vomiting
- has mouth or throat pain when he or she eats
- has problems swallowing or pain when swallowing
- refuses food repeatedly, causing weight loss or poor growth
- shows signs of dehydration, such as no tears when he or shes cries
How do doctors diagnose GER in children and teens?
In most cases, a doctor diagnoses gastroesophageal reflux (GER) by reviewing a child or teen’s symptoms and medical history. If symptoms of GER do not improve with lifestyle changes and anti-reflux medicines, he or she may need testing.
How do doctors diagnose GERD in children and teens?
If a child or teen’s GER symptoms do not improve, if they come back frequently, or he or she has trouble swallowing, the doctor may recommend testing for gastro esophageal reflux disease (GERD).
The doctor may refer the child or teen to a pediatric gastroenterologist to diagnose and treat GERD.
What tests do doctors use to diagnose GERD?
Several tests can help a doctor diagnose GERD. A doctor may order more than one test to make a diagnosis.
Upper GI Series
An upper GI series looks at the shape of the child or teen’s upper GI tract.
During the procedure, the child or teen will drink liquid contrast (barium or gastrograffin) to coat the lining of the upper GI tract. The x-ray technician takes several x-rays as the contrast moves through the GI tract. The technician or radiologist will often change the position of the child or teen to get the best view of the GI tract. They may press on the child’s abdomen during the x-ray procedure.
The upper GI series can’t show mild irritation in the esophagus. It can find problems related to GERD, such as esophageal strictures, or problems with the anatomy that may cause symptoms of GERD.
Children or teens may have bloating and nausea for a short time after the procedure. For several days afterward, they may have white or light-colored stools from the barium. A health care professional will give you specific instructions about the child or teen’s eating and drinking after the procedure.
Esophageal pH and impedance monitoring
The most accurate procedure to detect acid reflux is esophageal pH and impedance monitoring. Esophageal pH and impedance monitoring measures the amount of acid or liquid in a child or teen’s esophagus while he or she does normal things, such as eating and sleeping.
This procedure takes place at a hospital or outpatient center. A nurse or physician places a thin flexible tube through the child or teen’s nose into the stomach. The tube is then pulled back into the esophagus and taped to the child or teen’s cheek. The end of the tube in the esophagus measures when and how much acid comes up into the esophagus. The other end of the tube attaches to a monitor outside his or her body that records the measurements. The placement of the tube is sometimes done while a child is sedated after an upper endoscopy, but can be done while a child is fully awake.
The child or teen will wear a monitor for the next 24 hours. He or she will return to the hospital or outpatient center to have the tube removed. Children may need to stay in the hospital for the esophageal pH and impedance monitoring.
This procedure is most useful to the doctor if you keep a diary of when, what, and how much food the child or teen eats and his or her GERD symptoms after eating. The gastroenterologist can see how the symptoms, certain foods, and certain times of day relate to one another. The procedure can also help show whether acid reflux triggers any respiratory symptoms the child or teen might have.
Upper Gastro Intestinal (GI) endoscopy and biopsy
In an upper GI endoscopy, a gastroenterologist, surgeon, or other trained health care professional uses an endoscope to see inside a child or teen’s upper GI tract. This procedure takes place at a hospital or an outpatient center.
An intravenous (IV) needle will be placed in the child or teen’s arm to give him or her medicines that keep him or her relaxed and comfortable during the procedure. They may be given a liquid anesthetic to gargle or spray anesthetic on the back of his or her throat. The doctor carefully feeds the endoscope down the child or teen’s esophagus then into the stomach and duodenum. A small camera mounted on the endoscope sends a video image to a monitor, allowing close examination of the lining of the upper GI tract. The endoscope pumps air into the child or teen’s stomach and duodenum, making them easier to see.
The doctor may perform a biopsy with the endoscope by taking small pieces of tissue from the lining of the child or teen’s esophagus, stomach, or duodenum. He or she won’t feel the biopsy. A pathologist examines the tissue in a lab.
In most cases, the procedure only diagnoses GERD if the child or teen has moderate to severe symptoms.
How do doctors treat GER and GERD in children and teens?
You can help control a child or teen’s gastroesophageal reflux (GER) or gastroesophageal reflux disease (GERD) by having him or her
- not eat or drink items that may cause GER, such as greasy or spicy foods
- not overeat
- avoid smoking and secondhand smoke
- lose weight if he or she is overweight or obese
- avoid eating 2 to 3 hours before bedtime
- take over-the-counter medicines, such as Alka-Seltzer , Maalox , or Rolaids
How do doctors treat GERD in children and teens?
Depending on the severity of the child’s symptoms, a doctor may recommend lifestyle changes, medicines, or surgery.
Helping a child or teen make lifestyle changes can reduce his or her GERD symptoms. A child or teen should
- lose weight, if needed.
- eat smaller meals
- avoid high-fat foods
- wear loose-fitting clothing around the abdomen. Tight clothing can squeeze the stomach area and push the acid up into the esophagus.
- stay upright for 3 hours after meals and avoid reclining and slouching when sitting.
- sleep at a slight angle. Raise the head of the child or teen’s bed 6 to 8 inches by safely putting blocks under the bedposts. Just using extra pillows will not help.
- If a teen smokes, help them quit smoking and avoid secondhand smoke .
Over-the-counter and prescription medicines
If a child or teen has symptoms that won’t go away, you should take him or her to see a doctor. The doctor can prescribe medicine to relieve his or her symptoms. Some medicines are available over the counter.
All GERD medicines work in different ways. A child or teen may need a combination of GERD medicines to control symptoms.
Doctors often first recommend antacids to relieve GER and other mild GERD symptoms. A doctor will tell you which over-the-counter antacids to give a child or teen, such as
H2 blockers decrease acid production. They provide short-term or on-demand relief for many people with GERD symptoms. They can also help heal the esophagus, although not as well as other medicines. If a doctor recommends an H2 blocker for the child or teen, you can buy them over the counter or a doctor can prescribe one. Types of H2 blockers include
If a child or teen develops heartburn after eating, his or her doctor may prescribe an antacid and an H2 blocker. The antacids neutralize stomach acid, and the H2 blockers stop the stomach from creating acid. By the time the antacids wear off, the H2 blockers are controlling the acid in the stomach.
Don’t give your child or teen over-the-counter H2 blockers without first checking with his or her doctor.
Proton pump inhibitors (PPIs)
PPIs lower the amount of acid the stomach makes. PPIs are better at treating GERD symptoms than H2 blockers.2 They can heal the esophageal lining in most people with GERD. Doctors often prescribe PPIs for long-term GERD treatment.
However, studies show that people who take PPIs for a long time or in high doses are more likely to have hip, wrist, and spinal fractures. A child or teen should take these medicines on an empty stomach so that his or her stomach acid can make them work correctly.
Several types of PPIs are available by a doctor’s prescription, including
- esomeprazole (Nexium)
- lansoprazole (Prevacid)
- omeprazole (Prilosec, Zegerid)
- pantoprazole (Protonix)
- rabeprazole (AcipHex)
Talk with the child or teen’s doctor about taking lower-strength omeprazole or lansoprazole, sold over the counter. Don’t give a child or teen over-the-counter PPIs without first checking with his or her doctor.
Prokinetics help the stomach empty faster. Prescription prokinetics include
Both these medicines have side effects, including
- fatigue, or feeling tired
- delayed or abnormal physical movement
Prokinetics can cause problems if a child or teen mixes them with other medicines, so tell the doctor about all the medicines he or she is taking.
Antibiotics, including erythromycin , can help the stomach empty faster. Erythromycin has fewer side effects than prokinetics; however, it can cause diarrhea.
A pediatric gastroenterologist may recommend surgery if a child or teen’s GERD symptoms don’t improve with lifestyle changes or medicines. A child or teen is more likely to develop complications from surgery than from medicines.
Fundoplication is the most common surgery for GERD. In most cases, it leads to long-term reflux control.
A surgeon performs fundoplication using a laparoscope, a thin tube with a tiny video camera. During the operation, a surgeon sews the top of the stomach around the esophagus to add pressure to the lower end of the esophagus and reduce reflux.
The surgeon performs the operation at a hospital. The child or teen receives general anesthesia and can leave the hospital in 1 to 3 days. Most children and teens return to their usual daily activities in 2 to 3 weeks.
Endoscopic techniques, such as endoscopic sewing and radiofrequency, help control GERD in a small number of people. Endoscopic sewing uses small stitches to tighten the sphincter muscle. Radiofrequency creates heat lesions, or sores, that help tighten the sphincter muscle. A surgeon performs both operations using an endoscope at a hospital or an outpatient center, and the child or teen receives general anesthesia.
The results for endoscopic techniques may not be as good as those for fundoplication. Doctors don’t use endoscopic techniques.
How can diet help prevent or relieve GER or GERD in children and teens?
You can help a child or teen prevent or relieve their symptoms from gastro esophageal reflux (GER) or gastro esophageal reflux disease (GERD) by changing their diet. He or she may need to avoid certain foods and drinks that make his or her symptoms worse. Other dietary changes that can help reduce the child or teen’s symptoms include
- decreasing fatty foods
- eating small, frequent meals instead of three large meals
What should a child or teen with GERD avoid eating or drinking?
He or she should avoid eating or drinking the following items that may make GER or GERD worse
- greasy or spicy foods
- tomatoes and tomato products
What can a child or teen eat if they have GERD?
Eating healthy and balanced amounts of different types of foods is good for your child or teen’s overall health. For more information about eating a balanced diet, visit Choose My Plate.