Gastroesophageal Reflux in Babies and Children
What is gastroesophageal reflux?
Gastroesophageal reflux happens when food and stomach acid flow from the stomach back into the esophagus. The esophagus is the tube that carries food from the mouth to the stomach. In adults, reflux is often called heartburn or acid reflux.
Reflux is common in babies and children, and it is usually not a sign of a serious problem. Most babies stop having reflux around 1 year of age. A child who continues to have reflux may need treatment.
What causes reflux?
Reflux happens because of a problem with the ring of muscle at the end of the esophagus called the lower esophageal sphincter, or LES. The LES acts like a one-way valve between the esophagus and the stomach. When you swallow, it lets food pass into the stomach. If the LES is weak, stomach contents can flow back up into the esophagus.
In babies, this problem happens because the digestive tract is still growing. Reflux usually goes away as a baby matures.
What are the symptoms?
It is common for babies to spit up after they eat. Babies with reflux may spit up more forcefully. Babies with severe reflux may cry, act fussy, or have trouble eating. They may not sleep well or grow as expected.
Older children and teens may have the same symptoms as adults. They may cough a lot and have a burning feeling in their chest and throat (heartburn). They may have a sour or bitter taste in their mouth.
How is reflux diagnosed?
To find out if a child has reflux, a doctor will do a physical exam and ask about symptoms. A baby who is healthy and growing may not need any tests. If a teen is having symptoms, the doctor may want to see if medicines help before doing tests.
If a baby is not growing as expected or treatment doesn't help a teen, the doctor may want to do tests to help find the cause of the problem. Common tests include:
- A barium swallow, which is a series of X-rays that shows the esophagus and stomach.
- Endoscopy , which lets the doctor look at the esophagus.
- An esophageal pH test, which measures how much acid is in the esophagus.
How is it treated?
Most babies stop having reflux over time, so the doctor may just suggest that you follow some steps to help reduce the problem until it goes away. For example, it may help to:
- Burp your baby a few times during each feeding.
- Keep your baby upright for 30 minutes after each feeding. Avoid a "car seat position" because sitting can make reflux worse in babies.
- Avoid feeding too much at one time. Give your baby smaller meals more often.
- Keep your baby away from smoky areas.
For older children and teens, it may help to:
- Avoid large meals before exercise.
- Raise the head of your child’s bed 6 to 8 inches. Using extra pillows does not work.
- Have your child stay upright for 2 to 3 hours after eating.
- Serve 5 or 6 small meals instead of 2 or 3 big ones.
- Limit foods that might make reflux worse. These include chocolate, sodas that have caffeine, spicy foods, fried foods, and high-acid foods such as oranges and tomatoes.
- Keep your child away from smoky areas.
If these steps don't work, the doctor may suggest medicine. It is unclear how well medicines help children with reflux.1 Medicines that may be used include:
- Antacids, such as Mylanta and Maalox. Antacids neutralize stomach acid and relieve heartburn. You can buy these without a prescription.
- H2 blockers, such as ranitidine (Zantac) and cimetidine (Tagamet). H2 blockers reduce the amount of acid in the stomach. You can buy some of these without a prescription. For stronger doses, you will need a prescription.
- Proton pump inhibitors, such as esomeprazole (Nexium) and omeprazole (Prilosec). These medicines usually work best. You can buy some proton pump inhibitors without a prescription. But talk to your doctor before you give these medicines to your child.
Before you give your child any over-the-counter medicine:
- Read the label. Do not give a child any product that contains bismuth subsalicylate, such as Pepto-Bismol or Kaopectate. Experts think it may be linked to Reye's syndrome, a rare but serious illness.
- Be sure you understand how much and how often to give the medicine to your child. If you are not sure, ask your doctor.
Children with reflux rarely need surgery. It may be an option for babies or children who have severe reflux that causes breathing problems or keeps them from growing.
Other Places To Get Help
|KidsHealth for Parents, Children, and Teens|
This Web site provides a wide range of information about children's health, from allergies and diseases to normal growth and development (birth to adolescence). This Web site offers separate areas for kids, teens, and parents, each providing age-appropriate information that the child or parent can understand. You can sign up to get weekly emails about your area of interest.
|American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS)|
|1650 Diagonal Road|
|Alexandria, VA 22314-2857|
The American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) is the world's largest organization of physicians dedicated to the care of ear, nose, and throat (ENT) disorders. Its Web site includes information for the general public on ENT disorders.
|National Digestive Diseases Information Clearinghouse (NDDIC)|
|2 Information Way|
|Bethesda, MD 20892-3570|
This clearinghouse is a service of the U.S. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the U.S. National Institutes of Health. The clearinghouse answers questions; develops, reviews, and sends out publications; and coordinates information resources about digestive diseases. Publications produced by the clearinghouse are reviewed carefully for scientific accuracy, content, and readability.
|North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN)|
|P.O. Box 6|
|Flourtown, PA 19031|
NASPGHAN promotes advances in clinical care, research, and education for infants, children, and teens with digestive disorders. The family resources page of this Web site has information about pain in the belly, diarrhea, constipation, vomiting, poor weight gain, nutritional problems, and diseases of the liver, bowel, and pancreas.
- Kumar Y, Sarvananthan R (2007). Gastro-oesophageal reflux in children, search date July 2006. Online version of BMJ Clinical Evidence. Also available online: http://www.clinicalevidence.com.
Other Works Consulted
- Mazur LJ, Smith HD (2006). Gastroesophageal reflux. In FD Burg et al., eds., Current Pediatric Therapy, 18th ed., pp. 532–535. Philadelphia: Saunders Elsevier.
- McEvoy CF (2006). Sucking and swallowing disorders and gastroesophageal reflux. In JA McMillan et al., eds., Oski's Pediatrics: Principles and Practice, 4th ed., chap. 57, pp. 382–384. Philadelphia: Lippincott Williams and Wilkins.
- Orenstein S, et al. (2007). Gastroesophageal reflux disease (GERD). In RM Kliegman et al., eds., Nelson Textbook of Pediatrics, 18th ed., pp. 1547–1550. Philadelphia: Saunders Elsevier.
- Proton pump inhibitors for GERD in children (2007). Medical Letter on Drugs and Therapeutics, 49(1255): 17–18.
|Author||Debby Golonka, MPH|
|Editor||Susan Van Houten, RN, BSN, MBA|
|Associate Editor||Tracy Landauer|
|Primary Medical Reviewer||Michael J. Sexton, MD - Pediatrics|
|Specialist Medical Reviewer||Thomas Emmett Francoeur, MDCM, CSPQ, FRCPC - Pediatrics|
|Last Updated||April 8, 2008|
Last Updated: April 8, 2008
Author: Debby Golonka, MPH