Gastro-esophageal reflux (GERD) in Children

7/19/2007

It’s a big name for a very common problem. Gastro-esophageal reflux, or GERD, is something like a child’s version of adult heartburn. However, it shows up in a wider variety of ways:

• Frequent spitting up or vomiting
• irritability before or after feedings
• recurrent ear infections
• chronic cough
• chest pain
• spells of turning blue (cyanosis)

The most common presentation for reflux in a young baby is spitting up. There are two kinds of spitters:

• “Healthy spitters” have a developmental problem with the muscle that closes the lower esophagus during digestion. That muscle is still immature, and allows partially digested food or milk to escape the stomach and come back up. The baby spits up a lot, but does not feel pain from it.
• “Painful spitters” are babies who feel a burning pain in the esophagus due to the stomach acid present in the partially digested milk or secretions. These babies often arch their backs, and some develop strange writhing movements of the arms and upper body (Sandifer Syndrome). Although they don’t always actually spit up, the burning feeling does cause pain during and after feeding.

Healthy spitters need no treatment other than being placed at a 45-degree angle after feedings. They will outgrow this problem by their first birthday. Painful spitters, however, should be treated so they don’t begin to shy from feeding because of the pain. Among the useful approaches:

• Breast-feeding moms should consider eliminating milk and dairy from their own diet. The casein in the milk a mother drinks crosses into the breast milk, and can trigger digestive issues in baby.
• If the baby is normally fed a milk- or soy-based formula, consider a change to a pre-digested protein hydrolysate formula such as Nutramigen® and Alimentum®.
• Prescription antacid medications such as Ranitidine®, Omeprazole®, or Prevacid® treat the pain associated with GERD. An improvement may be seen within days, or within a few weeks at most.

But what’s the connection between GERD and coughs and ear infections? GERD causes secretions to trickle into the upper airway or the Eustachian tubes leading to the ear. This can lead to either an intractable cough or recurrent ear or sinus infections. If your child has recurrent ear infections or fluid in the middle ear, ask your pediatrician about the possibility of reflux. Happily, once reflux is treated, the fluid or recurrent ear infections often resolve.

Sometimes GERD shows up in a child as chest pain. This really scares parents, because as adults they associate chest pain with serious conditions like heart attack or angina. But chest pain in children is rarely caused by heart problems, except in those with congenital heart disease. Usually the chest pain in a child is caused by the irritation of the esophagus by regurgitated stomach acids. These children respond beautifully to a change in diet (i.e., elimination of dairy foods) and/or anti-reflux medications.

Usually your pediatrician can treat GERD, but if standard nutritional and medication therapy is not successful or if a very small infant suffers spells of turning blue due to reflux, then a referral to a pediatric gastroenterologist is in order. This specialist can perform an upper endoscopy to directly visualize the area of involvement and assess the degree of inflammation.