Gastroesophageal Reflux (GERD) in Children and Adolescents

What is GERD?

The passage of gastric contents into the esophagus (gastro-esophageal reflux) is a normal process that occurs in healthy infants, children, and adults. Most episodes are brief and do not cause symptoms, esophageal injury, or other complications. In contrast, gastro-esophageal reflux disease (GERD) is present when the reflux episodes are associated with symptoms or complications.

What are the symptoms of GERD?

The range of symptoms and complications of GERD in children and adolescents vary depending upon their age.

• Preschool: Preschool age children with GERD may present with intermittent vomiting or regurgitation. They may complain about upper abdominal pain, or that their "tummy feels funny." Less commonly, they may have respiratory symptoms such as chronic cough, wheeze, or hoarseness. Decreased food intake or poor weight gain without any other complaints may be symptoms of GERD in young children.
• Older children and adolescents: The pattern of symptoms and complications in older children and adolescents resembles that seen in adults. The cardinal symptom is chronic "heart-burn," or pain in the upper abdomen (under the breastbone). In younger children, the pain is often ill-defined. In older children, it may be described as squeezing or burning, and may radiate to the back or upward along the esophagus. Other symptoms include nausea, poor appetite, feeling full or bloated easily, belching, chest pressure, difficult or painful swallowing, and/or an acidic taste in the mouth. The pain or discomfort often occurs after meals, especially large meals, and typically resolves in minutes to hours spontaneously or after administration of antacids. Respiratory symptoms can also occur, including chronic cough, wheeze, hoarseness, and even pneumonia or sinusitis.

What symptoms make a diagnosis of GERD unlikely?

Diarrhea and constipation are not symptoms of GERD, and make GERD as a sole diagnosis unlikely. Warning signs that your child has something more serious include bloody, bilious (green), or forceful vomiting, weight loss, persistent fevers, or bloody stools. If any of the above warning signs are present, please contact our office to discuss.

How is GERD diagnosed?

GERD is usually diagnosed presumptively by the clinical constellation of symptoms. If GERD is suspected, then an acid blocker or acid suppressor is usually prescribed. If the patient gets better, then GERD is assumed to be the correct diagnosis. GERD can be diagnosed more definitively by inserting a probe into the distal esophagus and measuring the pH of the regurgitated fluid. Alternatively, it can be diagnosed by seeing inflammation or irritation of the esophageal lining during endoscopy (direct visualization of esophagus with a camera). Since these tests are fairly invasive, they are reserved for more complicated or severe cases.

Treatment of GERD

• Diet: People who suffer from GERD should eat small, frequent meals. It is also helpful to avoid eating in the two hours prior to bedtime. Certain foods tend to make reflux worse. Try to avoid acidic or overly fatty foods, and foods that contain caffeine or peppermint. Sodas and orange juice are very acidic and can exacerbate reflux.
• Positioning: Try not to lie flat for 2 hours following meals. It may help to elevate the head of your bed 6-8 inches.
• Weight control: If you or your child is overweight, losing weight often decreases reflux symptoms.
• Medications: Antacids are often helpful for occasional relief of reflux symptoms. Children 1-5 years old can have 1-2 tsp of Maalox or other liquid antacid every 6 hours as needed for one to two days. Children 6-12 years old can have 2-4 tsp per dose, and adolescents over age 12 can have the adult dosage. Antacids should not be used on a daily basis without discussing with our office.
• Acid blocking medications: These medications, such as Pepcid, Axid, and Zantac, block the effects of acid secretion. They can be taken on a daily basis to help prevent reflux symptoms. These medications are best taken 20-30 minutes before a meal, so that the medicine has taken effect prior to food consumption.
• Acid suppressing medications: These medications, such as Prevacid, Prilosec, and Nexium, are the most potent reflux medications. These medications turn off acid secretion in the stomach. We will often prescribe these medications if diet, lifestyle changes, and acid-blocking medications are not effective.

Complications of GERD

Longstanding untreated GERD can lead to serious complications, including esophageal ulcers or strictures, or lung disease. The most serious, and thankfully, rare complication is esophageal cancer.