Toddlers are prone to stomach upset, due in part to the immaturity of their digestive system. Acid reflux -- the backward flow of stomach contents into the food pipe, or esophagus -- is very common and usually harmless in infants. As babies reach their first birthday and become toddlers, acid reflux typically becomes increasingly less frequent. For a small percentage of toddlers, however, acid reflux persists and may cause troublesome symptoms, which can range in severity from an occasional "tummy ache" to an ongoing refusal to eat and failure to grow normally.
Vomiting and Sour Burps
The most visible symptom of acid reflux in toddlers is spitting up or vomiting, especially when their stomach is full. In a young toddler, spitting up is more common. In older toddlers, more typical vomiting -- with some force behind it -- is often present. Sometimes, the refluxed stomach contents reaches the child's upper throat or mouth but is reswallowed. With these "sour burps," you may notice a sour smell on your toddler's breath. Occasional vomiting in a toddler who is unfazed by it and quickly returns to normal activities generally isn't cause for concern. However, repeated vomiting along with other symptoms may indicate a digestive condition known as gastroesophageal reflux disease, or GERD.
Heartburn and Irritability
Like adults, toddlers with acid reflux may experience heartburn after eating -- but may not be able to express what they are feeling. Toddlers with a developed vocabulary may state their chest or stomach hurts. Younger toddlers may hold their hands to these areas or just seem more irritable and prone to crying after meals. Heartburn can make it difficult for a toddler to sleep, especially if trying to nap shortly after a meal or snack. The sleep disturbance can further aggravate a toddler's irritability.
Eating Aversion and Poor Growth
Toddlers with acid reflux severe enough to lead to a diagnosis of GERD commonly refuse to eat. Some toddlers can be coaxed into eating but may cry frequently during meal or snack times. This may be related to difficult or painful swallowing resulting from the effects of acid reflux on the child's esophagus. Poor growth, failure to gain weight normally or weight loss may result. These concerning symptoms typically warrant additional testing to check for other possible causes of the child's eating difficulties.
GERD in toddlers can cause inflammation of the throat and upper airway, leading to symptoms such as a persistent cough or hoarse voice. Some children may also exhibit wheezing or stridor -- a high-pitched, noisy breathing sound. In severe cases, the baby teeth of toddlers with GERD may begin to erode due to frequent exposure to stomach acid.
When To See a Doctor
Toddlers with occasional symptoms of acid reflux who are otherwise happy, healthy and growing normally are generally not at risk of harm and will likely outgrow their symptoms. However, if your child has any of the more serious symptoms that may be associated with GERD -- such as frequent vomiting, refusal to eat, failure to gain weight normally or a chronic cough -- schedule an appointment with your child's doctor as soon as possible.
Is This an Emergency?
- Pediatrics: Gastroesophageal Reflux: Management Guidance for the Pediatrician
- Journal of Pediatric Gastroenterology and Nutrition: Pediatric Gastroesophageal Reflux Clinical Practice Guidelines
- Journal of Pediatric Health Care: Gastroesophageal reflux disease in infants and children
- Journal of Medical Economics: Pediatric Gastroesophageal Reflux Disease and Acid-related Conditions: Trends in Incidence of Diagnosis and Acid Suppression Therapy