GERD in Children: What Parents Need to Know
Updated: Dec 5, 2023
GERD Awareness Week 2023 is here from November 19-25, and as your trusted source for all things related to ear, nose, and throat health, we're here to shed light on an important topic: GERD in children.
GER VS. GERD
Gastroesophageal reflux (GER) is the backflow of stomach contents into the esophagus. It is a common condition that can affect people of all ages. GER is often caused by a weak or relaxed lower esophageal sphincter (LES), the muscle that separates the esophagus from the stomach.
Gastroesophageal reflux disease (GERD) is a more serious and long-lasting form of GER. It occurs when GER happens two or more times a week. GERD can irritate the esophagus and cause damage, which can lead to complications such as esophageal cancer.
Here is a table that summarizes the key differences between GER and GERD:
Characteristic | GER | GERD |
Definition | Backflow of stomach contents into the esophagus | More serious and lasting form of GER |
Frequency | Occurs occasionally | ​Occurs two or more times a week |
Symptoms | Heartburn, regurgitation, vomiting | Heartburn, regurgitation, vomiting, difficulty swallowing, hoarseness, chronic cough, wheezing, chest pain |
Complications | None | Esophageal cancer, Barrett's esophagus, other esophageal conditions |
Treatment | Lifestyle changes, over-the-counter medications | Prescription medications, surgery |
GER tends to occur frequently in infants under the age of 2. Typically, during the initial three months, most babies experience periodic episodes of spitting up. GER usually doesn't pose any issues for infants and, in many instances, resolves itself by the time they reach 12 to 14 months of age.
In children and teenagers aged 2 to 19, occasional episodes of GER are quite common.
However, it's important to note that the presence of GER doesn't necessarily imply the presence of GERD.
Common Symptoms
Recognizing GERD in children can be challenging, as the symptoms may vary. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK NIH) shares the common signs including:
Frequent vomiting or spitting up
Gagging or nausea
Heartburn
Difficulty swallowing
Coughing, wheezing, or respiratory issues
Irritability during or after meals
Weightloss or failure to gain weight
Spotting GERD in Younger Children
There are a few ways to spot GERD in babies or infants. Here are some of the things to look for:
Arching of the back and abnormal movements of the neck and chin
Irritability or crying after eating
Refusing to eat or eating only small amounts
Loss of appetite or refusing to eat
Spitting up or vomiting frequently
Wet burps or wet hiccups
Coughing or wheezing
If you notice any of these signs or symptoms in your child, it is important to see a doctor to rule out GERD and other possible conditions.
Causes
Infants have a higher likelihood of having a weak lower esophageal sphincter (LES), a muscle that tends to relax when it should remain closed. During the digestion of food or milk, the LES may open, permitting stomach contents to flow back into the esophagus. This reflux can manifest in different ways ie. vomiting, GER, and at times, no symptom at all (Stanford Medicine, 2023).
Certain foods appear to influence the tone of the LES, causing it to remain open longer than usual. Such foods include chocolate, peppermint, and high-fat items. Additionally, some foods can stimulate the stomach to produce more acid, including citrus foods and tomato-based products.
Risk Factors
Some children are at an increased risk for developing GERD, including those who:
Have a family history of GERD
Are overweight or obese
Have delayed stomach emptying
Have a diaphragmatic hernia (a condition in which the diaphragm, the muscle that separates the chest from the abdomen, has a hole in it)
Have cerebral palsy
Have a neuromuscular disorder
Have a connective tissue disorder, such as Ehlers-Danlos syndrome
Are taking certain medications, such as corticosteroids or antibiotics
Treatment
Treatment for GERD in children depends on the severity of the condition and the underlying cause. In some cases, lifestyle changes, such as losing weight and avoiding eating before bed, may be enough to improve symptoms. In other cases, medication may be necessary.
Medications that are used to treat GERD in children include:
Antacids: These medications neutralize stomach acid.
H2 blockers: These medications reduce the amount of acid produced by the stomach.
Proton pump inhibitors (PPIs): These medications are the most effective medications for treating GERD. They work by blocking the production of stomach acid.
In some cases, surgery may be necessary to treat GERD in children. Surgery is typically only recommended for children with severe GERD that does not respond to other treatments.
What Parents Can Do to Help
Parents can help their children with GERD by:
Making sure their child eats a healthy diet and maintains a healthy weight
Feed their child at least 3 hours before their bedtime
Keeping their child's head elevated when they sleep
Avoiding triggers, such as spicy foods, caffeine, and chocolate
Giving their child medication as prescribed by their doctor
If you are concerned that your child may have GERD, it is important to see a doctor right away. Early diagnosis and treatment can help prevent complications.
