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Gastroesophageal Reflux in Children

(Gastroesophageal Reflux Disease [GERD])


The Manual's Editorial Staff

Reviewed/Revised Oct 2023
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What is gastroesophageal reflux disease (GERD)?

GERD (acid reflux) is a disease caused by your stomach contents and stomach acid flowing back up your esophagus. Your esophagus is the tube that connects your throat to your stomach. GERD is also common in adults.

  • Stomach acid can irritate and sometimes damage the esophagus

  • Sometimes stomach acid gets in your child's throat and down the windpipe

  • Nearly all babies have reflux and spit up sometimes

  • Babies with GERD may throw up, have problems eating or breathing, or be cranky

  • Children may have chest or abdominal pain, or heartburn

  • Doctors make changes to your child's diet and how you feed them, and prescribe acid-blocking medicine

  • Most babies outgrow reflux by about 18 months

What causes reflux in children?

A ring of muscle keeps the end of the esophagus closed. GERD happens when that muscle doesn't completely close off the esophagus and lets stomach contents flow back up into the esophagus.

Causes include:

  • Weak or underdeveloped muscles in lower part of the esophagus

  • Too much pressure in your child's stomach, such as from overfeeding or chronic lung diseases

Reflux is more likely when children:

  • Lie flat during or after feeding

  • Have a food or milk allergy

  • Are around cigarette smoke

  • Get caffeine or nicotine from their mother's breast milk

What are the symptoms of reflux in children?

Symptoms of reflux usually start shortly after birth and are worst around 6 or 7 months of age. Then symptoms slowly go away and are usually gone by about 18 months.

In babies, the most common symptoms are:

  • Throwing up

  • A lot of spitting up

If babies throw up a lot, they may not gain weight like they should. If acid gets in their throat and windpipe, babies may cough and wheeze.

In children, the most common symptoms are:

  • Chest pain

  • Belly pain

  • Sometimes heartburn (a burning pain in the chest)

In adolescents, the most common symptom is:

  • Heartburn

How can doctors tell if my child has reflux?

Doctors often base the diagnosis of reflux on your child's symptoms. If your child has severe symptoms, doctors may also do tests such as:

  • Barium study (an x-ray that use swallowed barium to help doctors see details of the digestive tract)

How do doctors treat GERD in children?

Treatment of GERD depends on your child’s age and symptoms.

For a baby, doctors may have you:

  • Thicken the baby's formula with some rice cereal

  • Hold the baby slightly upright to eat

  • Burp the baby more often

  • Use a special baby formula that doesn’t cause allergies (hypoallergenic formula)

  • Sometimes have your baby take an antacid medicine that neutralizes the stomach acid or an acid-suppressing medication

  • Sometimes raise the head of the crib about 6 inches (15 cm)

For an older child, doctors will have your child:

  • Not eat 2 or 3 hours before bedtime

  • Not drink bubbly (carbonated) drinks such as soft drinks or caffeine drinks such as coffee

  • Not take certain medicines

  • Not eat certain foods such as chocolate or fatty foods, or overeat

All children should be kept away from caffeine and cigarette smoke as these can make GERD worse.

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