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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.


Thumbnail image for the blog title "GERD in Children: What Parents Need to Know" in commemoration of GERD Awareness Week 2023 (November 19-25) by ENT Family. On the right side, a captivating vector illustration depicts a stomach with its contents seemingly bubbling out, effectively illustrating the condition.


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

Comprehensive Infographic: Recognizing GERD Signs & Symptoms in Children
Signs & Symptoms of GERD in Children / ENT Family

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.


Child appears to be experiencing discomfort, head tilted sideways and hand on stomach.
Ozgurcankaya / Getty Images Signature

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.




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Dr. David Eleff, Otolaryngologist/Ear, Nose, and Throat Specialist at ENT Family in Hollywood, Florida.

This article has been medically reviewed by  otolaryngologist, David Eleff, M.D.

ENT Family Blog

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