Nearly every baby spits up sometimes, which is a symptom of acid reflux, or GER -- gastroesophageal reflux. That's when the contents of his stomach, including acid, come back up into his esophagus, or even out of his mouth. And it's not just for infants; older children can have acid reflux too. But if your child vomits a lot, has heartburn or abdominal pain, it may be a sign of something more serious. Occasional acid reflux can develop into GERD -- gastroesophageal reflux disease -- which is more serious, and persistent, acid reflux.
Symptoms
In infants and children, the most common symptoms of acid reflux or GERD are the same: frequent choking, gagging, vomiting or regurgitation, sometimes with re-swallowing; heartburn, nausea, abdominal pain, or gas; frequent crying and fussy behavior associated with colic; or a persistent cough.
Most infants with acid reflux are otherwise healthy. However, some also have problems that affect their muscles, brain or nerves. Other issues that often go hand in hand with acid reflux or GERD include problems with feeding, poor growth, bad breath, recurrent pneumonia, sinus congestion, asthma, wheezing and other breathing difficulties.
Diagnosis
It's important to distinguish between standard acid reflux, or GER, and the more serious disease, GERD. If your infant has GER, he's quite likely still healthy and happy, even if he spits up or vomits often. GER is usually outgrown by a child's first birthday. If the reflux continues after your child turns a year old, it may be GERD.
A diagnosis of GERD is often missed in children, because of the variety of common symptoms, and other issues, that often occur along with it. For instance, your child's doctor might think it's just asthma, laryngitis or pneumonia, rather than realizing that those illnesses are a result of GERD.
Certain behavior could indicate that your child does have GERD, such as arching her back or being irritable during or immediately after eating. If your infant isn't growing properly, or refuses to eat, that could also indicate GERD.
Causes of Reflux
Usually, infants and children get acid reflux due to a gastrointestinal tract that's not optimally coordinated, and a sphincter that relaxes instead of closing tightly to keep food and acid down. This sphincter is called the LES, or lower esophageal sphincter, and it's the muscular valve between the esophagus and the stomach. There are some external factors that could also cause it to malfunction, especially in older children, including overeating, obesity and sensitivity to certain foods, beverages or medications.
Some of the foods that can worsen the symptoms of reflux are fatty or fried foods, spicy food, garlic, onions, chocolate, mint flavorings, caffeinated or alcoholic beverages, and foods high in acid. Those include citrus fruits and tomato-based foods, such as spaghetti sauce, pizza, chili and salsa. Obviously a child wouldn't likely be consuming alcohol, unless through breast milk, but many of the other culprits are favorites of small kids, from toddler age up.
See if your child is fussier or complains more after consuming some of these red flag foods, like French fries, chicken nuggets, pizza or a chocolate bar, or after drinking soda pop with caffeine in it, such as cola. If that's the case, cut out those types of foods and see if the symptoms lessen.
Medications that can cause reflux are those that contain aspirin, and non-steroidal anti-inflammatory drugs.
Causes of GERD
It's not entirely clear why some children with acid reflux develop GERD, but research has shown that the rest of the esophagus works well, even while the lower esophageal sphincter relaxes.
There may also be abnormal anatomy involved, such as a hiatal hernia. This condition occurs when the the upper stomach and LES get moved above the diaphragm, which is the wall of muscle that normally separates the stomach from the chest. A properly functioning diaphragm helps the LES keep stomach acid in the stomach, but a hernia allows the acid to rise more easily into the esophagus. This most often happens in older people, but can occur at any age.
GERD is also likely to be inherited, at least to a degree, since some families have more instances of it than others.
Treatments
Your child's doctor might prescribe a medication, but lifestyle changes are a better first treatment. Start off by elevating the head of your child's crib, bassinet or bed. Burp your baby often during a feeding, and keep him upright for 30 minutes afterwards; have older children remain upright for at least two hours after eating.
With a doctor's permission, you can thicken your baby's bottle feedings with cereal, try solid foods, or change his feeding schedule. For older children, serve smaller meals more often throughout the day; limit food, drinks and medications that may cause reflux; and encourage exercise.
