Acid reflux can strike at any age, and that includes infancy. Although usually associated with digestive symptoms such as a burning sensation in the chest, acid reflux can also cause respiratory problems, including nasal congestion, asthma and tightening of the airways. Congestion can refer to either an unwanted accumulation of fluids such as mucus in respiratory pathways or swelling of membranes that blocks the passage of air. Although acid reflux is a normal, harmless part of infancy, in some infants it can lead to problems that range in severity.
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Acid reflux can cause persistent nasal congestion in infants in several ways. This is important to watch out for because infants have small nasal passages that are easily obstructed, and anything that diminishes nasal clearance can cause considerable distress. Congestion is particularly troublesome for infants from the ages of 1 to 3 months old because they breathe only through their noses. Acidic gastric fluids congest the nose and airways by causing swelling, edema or inflammation, allowing mucus or gastric contents to become trapped in the nasal passages. In some cases regurgitated material can even be seen passing out through the nose, but this is not common. Common symptoms are nighttime snoring and coughing.
Throat and Esophageal Congestion
As with the nasal passages, the linings of the esophagus, throat and voice box may become irritated and inflamed with exposure to acidic gastric juices. In addition, infants with acid reflux may develop esophagitis -- inflammation of the esophageal lining. Symptoms of acid reflux can be difficult to discern in infants and are often attributed to colic or fussiness. Snoring, cough, difficulty swallowing and sudden tightening of muscles around the windpipe may result from acid reflux affecting the throat and voice box. Crying after every few swallows during feeding may be seen in cases of esophagitis. In severe cases, discomfort caused by GERD can lead to feeding refusal, irritability, poor weight gain and anorexia.
In rare cases, liquid or other foreign matter gets into the lungs. This is called aspiration, and while it is a serious health matter, it occurs only in a minority of infants who have severe acid reflux. Aspiration occurs when instead of draining back into the esophagus, digestive liquids from the stomach divert into the trachea and travel into the main airways of the infant’s lungs and beyond. Aspiration can damage the lungs by causing inflammation, infection and scarring. Acid reflux with aspiration has been strongly linked to numerous respiratory diseases in children and adults, including asthma, bronchitis and apnea, or a sudden pause in breathing. In rare cases, aspiration can lead to a life-threatening form of pneumonia.
Diagnosis and Treatment
If your infant exhibits respiratory symptoms associated with acid reflux, a qualified pediatrician should make the diagnosis. Changes in feeding and positioning, change in maternal diet if breastfeeding and elimination of dairy foods are among the lifestyle changes frequently recommended to resolve GERD in infants. Medications such as acid secretion suppressants and proton pump inhibitors may be prescribed. Over-the-counter versions should not be administered without a physician’s approval. For infants who are at risk for life-threatening complications, surgery may be an option.
Medical advisor: Jonathan E. Aviv, M.D., FACS