43% in the study group, with more than a third of patients (38.4%) showing an allergic reaction only to cow’s milk protein . Previous studies on food allergy (CMPA and immunoglobulin E-dependent allergy) in GERD in children have shown similar results reporting an association between 43% and 48% [17,18]. Understanding the natural history and outcomes of GERD in children is very important to identify patients at risk of GERD-related complications and the persistence of symptoms into the adulthood. In a longitudinal study, Orenstein et al. studied infants with GERD symptoms and histological changes in the esophagus in the first year of life and found that in a significant proportion of infants histology remained abnormal, despite complete resolution of symptoms without pharmacotherapy . In a retrospective/prospective cohort study of adolescents and young adults who were diagnosed in childhood with GERD, defined by erosive esophagitis, it was shown that later in life almost 80% of these patients had at least monthly heartburn and/or acid regurgitation and almost one third was taking either anti-secretory drugs or proton pump inhibitors .
Weight loss or failure to gain weight may occur as a result of excessive vomiting or poor feeding associated with acid reflux or GERD. A wet burp or wet hiccup is when an infant spits up liquid when they burp or hiccup. This can be a symptom of acid reflux or, less commonly, GERD. Infants are more prone to acid reflux because their LES may be weak or underdeveloped.
What Causes GERD in Babies and Children?
This ring of muscle is known as the lower esophageal sphincter (LES). The image is a representation of concomitant intraesophageal pH and esophageal electrical impedance measurements.
Outcomes are similar for both procedures. Depending on the child’s specific needs, a feeding tube may be placed in the stomach at the same surgery. Gastroesophageal reflux is often diagnosed based on the patient’s symptoms. A doctor or health care provider can evaluate your child for this condition.
Health & Parenting Guide
Reflux can cause sore throat and hoarseness. It may also cause sinusitis, ear infections and chronic cough. How might acid reflux lead to coughing and how is this diagnosed?
Gastroesophageal reflux disease (GERD) is a digestive disorder that’s referred to as pediatric GERD when it affects young people. Nearly 10 percent of teens and preteens in the United States are affected by GERD according to GIKids.
Infants are especially prone to regurgitate and it has been shown that the number of infants with this phenomenon decreases from about 80% during the first month of life to less than 10% at the age of one year . A study by Miyazawa et al. on 921 infants showed that over 47% of one-month-old infants have one or more regurgitation or vomiting episodes per day, however this number falls to just 6.4% by the age of seven months . Several factors contribute to exacerbate this phenomenon in the youngest infants, including the sole or predominantly liquid milk-based diet, the recumbent position and the immaturity of the function and structure of the gastro-esophageal junction .
- As previously mentioned, children with neurodevelopmental disabilities, including cerebral palsy, Down syndrome, and other heritable syndromes associated with developmental delay, have an increased prevalence of gastroesophageal reflux.
- Anything that causes the muscular valve between the stomach and esophagus (the lower esophageal sphincter, or LES) to relax, or anything that increases the pressure below the LES, can cause GERD.
- The major mechanism in infants and children has now been demonstrated to involve increases in tLESRs.
- Most of the time no tests are required to determine if a child has reflux.
- Symptoms of GERD may vary with a child’s age.
- Diagnostic evaluation includes abdominal ultrasound or barium swallow (see below).
What causes GERD?
The most important and initial treatment of reflux include lifestyle changes and reflux precautions. In babies, formula can be thickened to decrease the amount of spitting up, however this does not change the actual number of reflux episodes. Positioning a baby with his or her head slightly elevated can be useful. Visit our Acid Reflux / GERD category page for the latest news on this subject, or sign up to our newsletter to receive the latest updates on Acid Reflux / GERD. If an infant presents symptoms of GERD, it is important to get advice from a doctor or pediatrician as other, more severe, conditions share some of the symptoms of reflux in infants.
Avidan B, Sonnenberg A, Schnell TG, Sontag SJ. Walking and chewing reduce postprandial acid reflux. 22. Orenstein SR, McGowan JD. Efficacy of conservative therapy as taught in the primary care setting for symptoms suggesting infant gastroesophageal reflux. 21. Aksglaede K, Pedersen JB, Lange A, Funch-Jensen P, Thommesen P. Gastro-esophageal reflux demonstrated by radiography in infants less than 1 year of age.
H 2 RAs are superior to placebo in healing erosive esophagitis in pediatric populations . Nonetheless, unlike PPIs, H 2 RAs exhibit tachyphylaxis and tolerance and should not be considered in the long-term management of GERD. Current guidelines do not recommend routinely performing an upper gastrointestinal contrast study in the evaluation of children with suspected GERD. In selected patients, barium contrast studies may have a role to exclude conditions that may resemble GERD, such as achalasia, while, in infants, the barium meal can be useful for the diagnostic evaluation of malrotation, duodenal web and pyloric stenosis.
Another confounding factor is that the evaluation of GERD prevalence in children with respiratory disorders by using diagnostic methodologies cannot be extrapolated to the general population, as pediatric gastroenterologists generally investigate children only after the failure of conventional therapy. receptor antagonist prescriptions, this has raised questions about the possible effects of altered gastric pH on the development of food allergy. Based on animal studies, antacid medication impairs the gastric digestion of proteins, with the potential of forming novel dietary proteins, which in turn could promote specific IgE synthesis and lead to food allergy .
Frequent relapses or continuous symptoms are indications for prolonged PPIs therapy or surgery. The aim of this review is to provide an overview of GERD and to give a view of the state-of-the-art treatment of GERD in pediatrics. The provider may prescribe another type of medicine that helps the stomach empty faster if it’s clear that your child has a stomach-emptying delay.
In some cases, and particularly in children with neurodevelopmental disabilities, the presence of a chronically lax LES associated with decreased or even absent sphincter tone results in severe gastroesophageal reflux. Other complications noted in adults with gastroesophageal reflux, including Barrett esophagus and esophageal mucosal dysplasia, are uncommon in childhood. For patients who fail medical therapy, continuous intragastric administration of feeds alone (via nasogastric tube) may be used as an alternative to surgery. Most cases of pediatric gastroesophageal reflux are diagnosed based on the clinical presentation.