Gastric reflux, also known as gastroesophageal reflux or GER, occurs when acid from the stomach spills back into the esophagus. It's a common problem in young children and adolescents. Treatment options for children affected by GER include medications, surgery or lifestyle changes if the child isn't showing complications from the disorder. The type of treatment used depends on the severity of the reflux, the child's symptoms and the extent of damage to the esophagus, if any.
Medications
Medication therapy is often used in the treatment of gastric reflux in children, with many different functions. Medications such as Tagamet, Zantac and Pepcid--known as H2 antagonists--are used to slow the production of stomach acid. Other drugs, known as proton pump inhibitors, are used to block the production of stomach acid. These include Nexium, Prevacid and Prilosec. Finally, Reglan can be prescribed to help the stomach empty quicker. It's often used in conjunction with H2 antagonists or proton pump inhibitors.
Surgery
Surgery is an option used for the treatment of severe GER when medication management has failed. Symptoms of severe reflux include aspiration pneumonia, apnea, significant erosion of the esophagus, or failure to thrive. The most common surgery for reflux, called a Nissen Fundoplication, involves wrapping a section of the stomach around the lower part of the esophagus. This procedure helps prevent the backup of acid into the esophagus and can be performed laparoscopically, or by an open incision in the abdomen. The surgery is done on an in-patient basis under general anesthesia. The amount of time a child remains in the hospital after the procedure for laparoscopic Nissen Fundoplication is shorter than for an open incision (approximately three to four days).
Baby Formula Modifications
If a child younger than12 months has gastric reflux, switching to a hypoallergenic formula may help reduce the symptoms. Two separate studies, conducted by Rudolph CD, Mazur LJ, Liptak GS, et al and Orenstein SR, Shalaby TM, Di Lorenzo C, et al, say: "Because symptoms of milk protein allergy can overlap those of GERD in infants, a 2-week trial of hypoallergenic formula can be recommended in this age group."
Another strategy to reduce the symptoms of GER in infants is to thicken baby formula with rice cereal. Although this may not decrease the amount of acid that can back up into the esophagus, it can help reduce the frequency of vomiting and increase the number of calories in the formula. Vomiting is a common symptom of reflux and can cause a child to lose weight if it's severe.
Positioning Therapy
Children who have GER can benefit from sitting in a semi-upright position after eating. This position helps prevent stomach acid from backing up into the esophagus and keeps it in the stomach. Children should remain in this position for 20 to 30 minutes after eating to ensure stomach contents empty.
In children with reflux who are younger than 12 months, caregivers should consult with the child's pediatrician about sleep position after feedings. The American Academy of Pediatrics promotes the supine (back) positioning of infants younger than 1 to reduce the risk of Sudden Infant Death Syndrome (SIDS). Some children with GER may show a reduction of the symptoms in the prone (stomach) position, but additional precautions must be taken to ensure a safe sleep environment.
References
- "Laparoscopic Nissen Fundoplication"; The University of Washington Department of Surgery; 1998.
- Wong's Essentials of Pediatric Nursing"; Marilyn J. Hockenberry, PhD, RN-CS, PNP, FAAN; 2005.
- Rudolph CD, Mazur LJ, Liptak GS, et al. Guidelines for evaluation and treatment of gastroesophageal reflux in infants and children: recommendations of the North American Society for Pediatric Gastroenterology and Nutrition. J Pediatr Gastroenterol Nutr. 2001.
- "Guidelines for evaluation and treatment of gastroesophageal reflux in infants and children: recommendations of the North American Society for Pediatric Gastroenterology and Nutrition"; Rudolph CD, Mazur LJ, Liptak GS, et al; Journal of Pediatric Gastroenterology and Nutrition; 2001.
- "The spectrum of pediatric eosinophilic esophagitis beyond infancy: a clinical series of 30 children"; Orenstein SR, Shalaby TM, Di Lorenzo C, et al; American Journal of Gastroenterology; 2000.
