Gastroesophageal Reflux Disease
However, GERD can be difficult to diagnose in children. According to a customer survey in 2006 by Women’s Health Weekly, an average of more than two months passed after children first showed symptoms or complained of stomachaches before they were diagnosed with pediatric GERD. How can parents tell the difference between a little indigestion or the flu and full-blown GERD? How is the condition treated in young people?
GERD occurs when stomach acid backs up into the esophagus (the tube that connects the mouth to the stomach) during or after a meal. The muscular valve at the bottom of the esophagus is responsible for opening to let food down and closing to stop acid from coming up. In GERD, it opens or closes at the wrong time. When a baby spits up or vomits, they’re likely displaying the symptoms of GERD, which is considered common in infants.
GERD is a less common, more serious form of “spiting up.” Children and adolescents may be diagnosed with GERD if they show symptoms more than twice a week and experience other complications. Complications include respiratory problems, difficulty gaining weight, and inflammation of the esophagus (esophagitis).
The symptoms of childhood GERD are more serious than the occasional tummy ache or infrequent spitting up. GERD may be present in infants and preschool children if they:
- refuse to feed
- have poor weight gain
- develop breathing problems
- complain more than twice a week about abdominal pain or tummy aches
- vomit or complain of stomach acid or food in the throat or mouth
- resist eating or find it unpleasant
- choke and gag
- have excessive hiccups
- have weight loss
- have frequent coughing
- wheeze (GERD is reported to occur often in children with asthma)
GERD may be present in older children and adolescents if they:
- have pain or burning in the upper chest (heartburn)
- have pain or discomfort swallowing
- frequently cough or wheeze or have hoarseness
- have excessive belching
- have nausea
- taste stomach acid in the throat
- feel like food gets stuck in their throat
- have pain that's worse when lying down
Though scientists aren't always exactly sure what causes GERD in young people, there are several factors that may be involved, including:
- immaturity: in infants particularly, the muscle at the bottom of the esophagus that opens to allow food to pass and closes to prevent it from refluxing hasn't matured yet. As a result, it isn’t able to control acid backup as well as it should. Time should remedy this condition
- genetics: according to some studies, adults with GERD may have children who suffer from it as well
- injuries: certain sports injuries or traumatic events like car accidents may injure the valve at the bottom of the esophagus or cause it to stretch to the point where it can no longer completely seal
- weight: according to research from the Kaiser Permanente health group in Southern California, moderately obese children and teens are 30 percent more likely to have GERD
Some children may also have weak valves that are particularly sensitive to certain foods and beverages, or may have some inflammation in the esophagus that is causing the problem.
As in adults, treatment for pediatric GERD depends on the severity of the condition. Doctors will almost always advise parents, children, and teens to start with simple lifestyle changes. For example:
- Maintain an upright position. Hold babies upright while feeding and make sure children don't lie down for at least one hour after eating.
- Eat smaller meals more often, and avoid eating two to three hours before bedtime.
- Lose weight if necessary.
- Avoid spicy foods, high-fat foods, and acidic fruits and vegetables, which can irritate your stomach.
- Avoid carbonated beverages, alcohol, and tobacco smoke.
- Elevate the head during sleep.
- Avoid eating large meals before vigorous activities, sports games, or during times of stress.
- Avoid tight-fitting clothes.
If lifestyle remedies don't help the child feel more comfortable, doctors may recommend medications that help reduce the amount of acid the stomach produces. These medications include over-the-counter antacids, histamine-2 blockers that reduce acid in the stomach (Pepcid, Zantac), and proton-pump inhibitors (PPIs) that block acid (Nexium, Prilosec, Prevacid).
There is some debate on starting young children on these medications, particularly because it’s not yet known what the long-term effects may be. Parents concerned about these issues may want to help their children make lifestyle modifications or try some herbal remedies instead.
Surgery is rarely considered for pediatric GERD—and only in situations where serious complications like esophageal bleeding or ulcers can’t be otherwise controlled.
In addition to lifestyle changes, other natural remedies that may help relieve pediatric GERD include:
- melatonin: this is a naturally occurring hormone in humans which helps regulate sleep and wake cycles. A 2008 study indicated it may also help reduce the symptoms of acid reflux.
- ginger tea: ginger has demonstrated in many studies the ability to calm upset stomachs. Try adding the spice in your kids’ favorite baked goods, or try ginger tea during or after a meal.
- manuka honey: some anecdotal evidence indicates that honey's coating abilities and anti-bacterial and anti-inflammatory properties may help soothe the esophagus. (Honey should not be given to children younger than one year)
- aloe vera juice: some people have found that this juice relieves their symptoms.
Written by: Colleen M. Story
Medically reviewed by George Krucik, MD