It is normal for children of all ages to experience acid reflux -- the movement of stomach acid back up the esophagus toward the mouth. When that reflux causes problems such as pain in the chest or upper stomach, pain and inflammation in the sinuses, throat pain or hoarseness called laryngitis, recurrent pneumonia or hard-to-control asthma, it is called acid reflux disease. Children with acid reflux disease may get relief by avoiding certain foods and drinks and exposure to tobacco. If those changes are not enough, treatment may require medication and, in the very worst cases, surgery.
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Altering food intake and exposure to toxic substances is the first step in treating acid reflux disease in children. Chocolate and spicy foods can worsen reflux, and avoiding them may help decrease symptoms. Avoiding drinks with caffeine or high acid content such as soda, orange juice and bottled iced teas may also help. Breastfed infants with acid reflux disease may experience improvement if their mothers restrict cow's milk and eggs from their diet. Adding thickener to a baby's formula does not reduce the amount of acid that leaves her stomach, though it can keep it from reaching her mouth. Tobacco exposure, both directly through smoking and secondhand smoke, should be avoided, as should any alcohol ingestion.
In overweight adults with acid reflux, reducing excess weight is also a focus, but this effort is more complicated in children and should not be attempted without first consulting with your child's doctor. Babies also have less reflux when upright or lying on their stomachs, but the risk of sudden infant death syndrome outweighs any problem with reflux, and babies should only lie on their stomach when awake and closely monitored.
For children with acid reflux disease who continue to have symptoms despite the diet and exposure changes previously mentioned, medications may be used to decrease stomach acid and its effects. Antacids are commonly used to treat heartburn symptoms in adults but have not been shown to work in children. In addition, long-term use can cause problems, so these over-the-counter medications should only be used short-term in children. Only two major classes of prescription medications are used to treat children with acid reflux disease. Histamine-2 receptor antagonists block stomach cells that produce acid. Proton pump inhibitors block the last step in the secretion of acid in the stomach. They both can be helpful but also can cause unwanted side effects. Careful consideration with your child's healthcare provider should be undertaken before starting any of these medications.
For children with the most severe symptoms of acid reflux disease, in whom no other treatment has been effective, surgery may be considered. The most common procedure is called fundoplication and involves wrapping the upper part of the stomach around the lower part of the esophagus to try to stop the acid from moving back up the esophagus. There are significant risks to this procedure, and children are carefully screened before considering this intervention.
Warnings and Precautions
Most children with acid reflux will not have symptoms severe enough for treatment. But if your child has a recurrent sour taste in the mouth, recurrent upper abdominal pain or chest pain, recurrent laryngitis or sinus infections, asthma that is hard to get under control, difficulty gaining weight or recurrent pneumonia, see your child's healthcare provider soon to discuss if acid reflux disease could be the cause.
Medical advisor: Jonathan E. Aviv, M.D., FACS