Gastroesophageal reflux (GER), commonly known as acid reflux, is a common diagnosis in infants and children. It is one of the most common reasons for primary care visits and referrals to pediatric Gastroenterology (GI). GER occurs when liquids or solids pass from the stomach back into the food pipe, or esophagus, with or without vomiting. This is often a mild episode and can occur multiple times per day in healthy infants and children.
When GER is associated with troublesome symptoms, such as irritability, weight loss or poor weight gain, or other symptoms related to coughing and/or wheezing, it is referred to as gastroesophageal reflux disease (GERD).
What Are Some Common Symptoms?
Symptoms that are concerning for GER vary depending on the age of the child. In infants, it is sometimes hard to determine if there is GER. Spitting up after feedings can be normal in infants up to 6 months of age. They can also have some fussiness during or after feedings. The diagnosis of GERD can be concerning for infants who have poor weight gain, feeding refusal, and frequent vomiting. Older children may complain of heartburn, “acid” in their mouths, nausea, vomiting, difficulty swallowing, and occasionally abdominal or chest pain.
What Causes Reflux?
In infants, sometimes the natural barriers against reflux in our GI tract are not completely developed until later on, which increases the possibility of liquid or food passing from the stomach into the esophagus. In older children, other factors, such as certain trigger foods, medications, and obesity can contribute to reflux. Uncommonly, there may be anatomic issues with the GI tract or systemic disorders that can increase the risk of reflux, which are important to rule out by a physician.
How Is Gastroesophageal Reflux Diagnosed?
GER and GERD are both clinical diagnoses that are made when a physician takes a good history of the infant or child’s symptoms. Your primary care provider or GI provider will ask questions during the exam to rule out any concerning symptoms or findings that indicate more severe GERD. Though there are other tools and studies that can diagnose GER, they are somewhat invasive and are not recommended in the absence of concerning symptoms or clinical history.
How Is It Treated?
Recently, the guidelines pertaining to gastroesophageal reflux disease in infants and children changed in 2018 after a joint committee meeting between the pediatric GI societies in North America and Europe revised previous recommendations. The recommendation for infants is to do a trial of hypoallergenic formula (or maternal elimination diet for breast fed infants) before considering medications for acid suppression.
Additionally, changing the volume of feedings, thickening feedings, and changing feeding positions can also be beneficial. In children, the recommendations are to limit acid-suppression treatment with medications. When medications are indicated, it is generally recommend to give a fair trial of the medications for 4 to 8 weeks. If a child has trigger foods that lead to increased reflux symptoms, then it would be best to try to avoid those foods.
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