While acid reflux symptoms such as spitting up or vomiting are common in infants, this issue resolves in most children by their first birthday. For the children it continues to affect, symptom management involves learning to choose the foods that can prevent or minimize discomfort. Because of a lack of research on diet management of childhood acid reflux, most of the pediatric diet recommendations are based on expert opinion or derived from adult acid reflux guidelines. Overall, children with acid reflux are encouraged to eat a healthy diet that includes a variety of foods, with the understanding that certain foods -- such as caffeine, chocolate, mint, fatty foods and acidic or spicy foods -- may need to be avoided if they worsen symptoms.
Dairy and Calcium-Rich Foods
Fatty foods are digested more slowly, and in a child with acid reflux -- a condition in which the acidic stomach contents back up into the esophagus or throat -- the contents of a full stomach are more likely to regurgitate into the esophagus. Fat also relaxes the lower esophageal sphincter, or LES, the ring of muscle that connects the stomach and esophagus, and this muscle needs to stay tight to keep stomach contents from leaking into the esophagus. Although high-fat foods do not have to be restricted in a child prone to acid reflux, lower-fat dairy foods such as nonfat or low-fat milk, nonfat or light yogurt, cottage cheese, mozzarella cheese or other low-fat cheese may be better tolerated. For plant-based alternatives, calcium-fortified almond, soy or rice milk, soy yogurt and soy cheese are also appropriate choices for children.
Some protein foods are high in fat and may also worsen acid reflux symptoms in children. Lean or low-fat protein sources may be best tolerated. These foods include beans, tuna, fish, skinless chicken or turkey, lean beef or pork, eggs, lean lunch meat, quinoa -- a high-protein grain -- tofu or other soy-based meat alternatives. Nuts, seeds and peanut butter are also healthy protein choices, although when consumed in larger amounts these foods can add significant fat to the meal or snack. However, it's important to note that high-fat foods do not need to be avoided if they don't cause symptoms. Clinical practice guidelines outlined in the October 2009 "Journal of Pediatric Gastroenterology and Nutrition" do not support routine elimination of any food in the management of acid reflux. Instead, they support an individualized approach based on tolerance of foods.
Fruits and Vegetables
Although any fruit or vegetable can be included in the diet of a child with acid reflux, certain acidic foods, including citrus, or spicy foods such as tomato sauce or salsa may aggravate symptoms in some children by irritating the esophagus. In children who are known to have worsened symptoms from acidic foods, lower-acid choices include cucumbers, cauliflower, zucchini, lettuce, spinach, broccoli, celery, potatoes, carrots, avocados, melons, bananas and pears. However, rather than a sole focus on lower-acid choices, children should be encouraged to eat a variety of their favorite fruits and vegetables daily and only avoid the foods that seem to cause or worsen symptoms.
Grains, breads and cereals -- including rice, pasta, crackers, tortillas, bread, breakfast cereals and grits -- are staples in the diet of most children. In general, these foods are tolerated well and don't tend to aggravate acid reflux symptoms unless they are part of very large or high-fat meals. Whole grains such as whole-wheat bread, brown rice, oatmeal, popcorn and whole-grain crackers are also good sources of fiber, and eating more fiber not only promotes normal bowel movements but also provides a sense of fullness, making a child less likely to overeat. In addition to choosing healthy grains, eating smaller meals with healthful snacks instead of large meals can assist in symptom management.
Warnings and Precautions
When symptoms of childhood acid reflux are minor or infrequent, lifestyle management is the most common therapy. These strategies include weight loss if indicated and avoiding any foods that are known to cause or worsen symptoms. Common offenders include fatty, spicy or acidic foods, or items that decrease LES pressure such as chocolate, mint or caffeine. Avoid these foods only if they cause or worsen acid reflux symptoms, however. Frequent or severe acid reflux usually requires medication management. If a child has difficult or painful swallowing, refuses to eat or if frequent or severe acid reflux cannot be managed with lifestyle modifications, see your pediatrician. A registered dietitian can also assist with modifying the diet for individual tolerance while ensuring a nutritious diet to support growth and development.
REFERENCES & RESOURCES
- North American Society for Pediatric Gastroenterology, Hepatology and Nutrition: Summary of the 2009 Pediatric Gastroesophageal Reflux Clinical Practice Guidelines
- American Academy of Pediatrics: Gastroesophageal Reflux: Management Guidance for the Pediatrician
- Journal of Pediatric Gastroenterology and Nutrition: Pediatric Gastroesophageal Reflux Clinical Practice Guidelines
- Journal of Pediatric Gastroenterology and Nutrition: Gastroesophageal Reflux Disease (GERD) Impairs the Quality of Life in Pediatric Patients: 31
- Advanced Nutrition and Human Metabolism; Sareen S. Gropper, et al.
- Killing Me Softly From Inside; Jonathan E. Aviv, MD, FACS
- Nutrition Therapy and Pathophysiology; Marcia Nelms and Kathryn Sucher
- North American Society for Pediatric Gastroenterology, Hepatology and Nutrition: GERD in Children and Adolescents