GERD, or gastroesophageal reflux disease, is often associated with adults--but children, and even babies, can get it, too. Acid reflux is one of the most common symptoms of GERD, which can result in heartburn for older kids, and spitting up for babies. However, most babies that have reflux are still healthy, and outgrow it within a year; persistent or long-lasting symptoms of reflux are a sign of GERD.
The Facts
Acid reflux, or GER (gastroesophageal reflux), occurs when acid and other contents of the stomach move back up into the esophagus--because the sphincter, which is supposed to hold them down, relaxes when it should be closed. Reflux happens to almost everyone sometimes, but if it's happening after nearly every meal, and causes a lot of discomfort, it's likely to be GERD.
If your baby is vomiting or often fussy after feedings, no matter what he eats or how much--or if your older child often has heartburn, stomach pains or discomfort in the chest--you can reasonably suspect GERD. Kids can often outgrow it, but sometimes, it's more serious. If your child has a neurological or developmental condition, like cerebral palsy, he's more at risk for severe GERD.
Symptoms
In older kids and teens, frequent heartburn is the most common symptom. It's usually worse after meals, and can last up to two hours. In babies and young children, GERD can cause feeding problems, such as frequent vomiting, continuing to spit up past the first birthday, wet burps, wheezing or choking, crying after meals, refusal to eat, and lack of weight gain. Symptoms may be worse if the baby lies down after eating.
Complications
Constantly refluxing stomach acid can lead to complications in some kids, including redness, bleeding or scar tissue in the esophagus, or breathing problems and asthma-like symptoms. These issues can make eating uncomfortable and cause your child to lose weight.
Diagnosis
Sometimes, GERD is not diagnosed in kids, because the symptoms can appear to indicate asthma, laryngitis or pneumonia; sometimes, those diseases are indeed also present, brought on by the GERD. In younger children and babies, arching of the back after eating, refusing to eat, or not growing properly will raise a red flag. Keeping track of what foods cause the symptoms will help in diagnosing your child.
Further tests may be done to confirm the diagnosis in young children who can't describe the symptoms. Those include X-rays combined with a barium swallow or milk scan; an upper endoscopy, in which a doctor looks into the stomach with a fiber optic camera; and, most commonly, a 24-hour pH-probe study, in which a thin tube is run through the nose into the esophagus to measure acid levels.
Causes
Doctors don't know exactly why some children develop GERD, but the rest of the esophagus usually works well, and just the sphincter malfunctions. A hiatal hernia can contribute to the problem; in this situation, the upper stomach gets moved above the diaphragm--the wall that normally separates the stomach from the chest. GERD also may be inherited, since some families have more cases of it than others.
Treatment
To lessen symptoms in a baby, you can burp him often and thicken his breast milk or formula with rice cereal. For an older child, monitor her symptoms after eating foods that typically trigger GERD, such as spicy, fatty or fried foods; onions and garlic; acidic foods like citrus fruits and tomatoes; chocolate; peppermint; and caffeine.
In children of all ages, eating smaller meals in an upright position and refraining from lying down for a while after eating also helps; the duration should be 30 minutes for babies and at least two hours for older kids. Also try raising the head of your child's bed or crib by 6 to 8 inches, using wooden blocks, to prevent her from sleeping completely horizontally, which lets acid splash back up more easily.
If none of this works, your child's doctor might prescribe medication, such as proton pump inhibitors (which make the stomach produce less acid) or H2 blockers (which block acid production). In extreme cases, surgery might be recommended, in which a new valve is created at the top of the stomach.
