Gastroesophageal Reflux in Children
Gastroesophageal refers to the
stomach and esophagus. The esophagus is the tube that connects the throat to the
stomach. Reflux means to flow back or return. Reflux happens because the lower
esophageal sphincter in babies opens easily. This allows the acidic stomach juices,
food, and fluids to flow back into your child’s esophagus.
Reflux can happen at any age, but
it’s common in babies. It is often a short-term (temporary) problem. But if it becomes
long-term problem, it is called gastroesophageal reflux disease (GERD).
Reflux is often caused by problems
with the lower esophageal sphincter. This is a muscle at the bottom of the esophagus.
Normally, it opens to let food into the stomach and closes to keep food in the stomach.
When this muscle relaxes too often or for too long, acid goes back into the esophagus.
This causes nausea, vomiting, and heartburn.
As babies digest their food, the
lower esophageal sphincter may open. This lets stomach contents go back up into your
child’s esophagus. Sometimes the contents go all the way up. This causes your baby
vomit. Sometimes acid or material can pass into the windpipe (trachea) and cause
coughing or infection. Other times, the contents may only go part of the way up the
esophagus. This can cause heartburn or breathing problems. Or it may not cause
Symptoms can occur a bit differently in each child. They can include:
- Coughing often
- Fussiness around mealtimes
- Getting ear infections often
- Having coughing fits at night
- Not wanting to eat
- Rattling sound in the chest
The symptoms of this condition may
be similar to symptoms of other health problems. Have your child see their healthcare
provider for a diagnosis.
Your child’s healthcare provider
will examine your child and check their health history. Your child may need the
following tests to diagnose reflux.
A chest X-ray is done to look for signs of aspiration. Aspiration happens when the
stomach contents spill into the lungs. This causes breathing problems and lung infections.
Upper GI (gastrointestinal) series
An upper GI series looks at the
organs in the upper part of your child’s digestive system. These include the
esophagus, stomach, and the first section of the small intestine (duodenum). For this
test, your child will swallow barium. This is a chalky white substance that coats
inside of their organs and can be seen on X-rays. Then your child’s healthcare
provider will take an X-ray of these organs.
In this test, a small, flexible
tube (endoscope) is used to look at the inside of your child’s digestive tract. This
tube has a light and a camera lens at the end of it. During the test, your child may
have tissue samples removed from their digestive tract. The samples are sent to a
to be looked at.
This test measures the level of acidity in your child’s esophagus.
Gastric emptying studies
This test will show if your
child’s stomach contents empty into their small intestine the correct way. Delayed
gastric emptying can cause reflux.
Treatment will depend on your child’s symptoms, age, and general health. It will also
depend on how severe the condition is.
Most babies with reflux have no symptoms other than spitting up often. As long as
these children grow well and don’t have other issues caused by reflux, they don’t
Sometimes reflux can be managed with feeding changes. These changes should be made
under the care of your baby’s healthcare provider. These can include:
- Hold your baby upright for 30
minutes after feedings. Ask your child’s healthcare provider about the best
position for your baby to sleep.
- Keep the nipple of the bottle
filled with milk if you’re bottle-feeding. This can keep your baby from swallowing
air when eating. Use a nipple that allows your baby’s mouth to make a good seal
with the nipple.
- Add rice cereal to a feeding. This
may help some older babies.
- Burp your baby several times when
bottle-feeding or breastfeeding. Your baby may spit up more often when burping
with a full stomach.
- Make sure your baby’s diaper isn’t
too tight. This can make reflux worse.
- Consider smaller and more frequent feedings.
Your baby may need reflux medicine. These medicines can decrease the amount of acid
the stomach makes. This will ease the heartburn caused by reflux.
Some babies with reflux may vomit often. This can keep them from gaining weight. In
this case, your baby’s healthcare provider may suggest the following:
- Adding rice cereal to your baby’s formula
- Prescribing a supplement to add calories to your baby’s diet
- Changing your baby to a milk-free
or soy-free formula. Your child’s healthcare provider may do this if their thinks
your child has an allergy.
Some babies with reflux have other conditions that make them tired. These can include
heart disease or being born premature. These babies may not be able to eat much before
getting sleepy. Other babies can’t keep a normal amount of formula or breastmilk in
their stomachs without vomiting. These babies may do better if they eat a small amount
of food continuously.
In these cases, your child’s
healthcare provider may advise tube feedings. A tube is placed in your child’s nose
and guided through the esophagus and stomach. This is called a nasogastric tube.
These tubes can also be used to bypass the stomach if needed. Tube feedings can be
done with or in place of bottle-feeding or breastfeeding.
In severe cases, your child may need surgery. This surgery is done to reinforce the
lower esophageal sphincter. This helps keep the reflux from happening.
Some babies with reflux may not vomit. Instead, their stomach contents may move up
and spill over into the windpipe (trachea). This can cause wheezing and pneumonia.
In rare cases, this can be life-threatening.
Babies with reflux who vomit often
may not gain weight and grow normally. This can cause inflammation (esophagitis) or
sores (ulcers) in the esophagus. These ulcers can be painful. They may also bleed.
can lead to anemia. This means too few red blood cells in the bloodstream. Over time,
this may cause long-term problems. These can include esophageal narrowing (stricture)
and abnormal cells in the lining of the esophagus (Barrett’s esophagus).
Many babies with reflux will outgrow it by the time they are age 1. This is when the
lower esophageal sphincter becomes stronger. For other babies, feeding and lifestyle
changes and medicine can help. Work with your child’s healthcare team to create a
care plan for your child.
When to Call a Healthcare Provider
Call your child’s healthcare provider if your child vomits after every feeding or
has new reflux symptoms.
- Gastroesophageal reflux is a digestive
- It causes acidic stomach juices, food,
and fluids to flow back into your child’s esophagus.
- This condition can occur at any age,
but it’s common in babies.
- Most babies with reflux have no
symptoms other than spitting up often. As long as your baby is growing well and has
no other reflux symptoms, they won’t need treatment.
- Holding your baby upright for 30
minutes after feedings, reducing how much air they swallow, and burping them well
during feedings may relieve reflux.
Tips to help you get the most from a visit to your child’s healthcare provider:
- Know the reason for the visit and what you want to happen.
- Before your visit, write down questions you want answered.
- At the visit, write down the name of a new diagnosis, and any new medicines, treatments,
or tests. Also write down any new instructions your provider gives you for your child.
- Know why a new medicine or treatment
is prescribed and how it will help your child. Also know what the side effects
- Ask if your child’s condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if your child does not take the medicine or have the test or procedure.
- If your child has a follow-up appointment, write down the date, time, and purpose
for that visit.
- Know how you can contact your child’s provider after office hours. This is important
if your child becomes ill and you have questions or need advice.