• Heartburn: Not Just for Adults—Kids Get It Too

    girl holiding cupcake Your family has just finished dinner when someone at the table starts feeling a burning sensation in their chest. It is not your spouse or Aunt Mabel, but your child. The burning sensation, or heartburn, is one symptom of gastroesophageal reflux disease (GERD).
    GERD happens when acid and food flow back up from the stomach and into the esophagus (the tube that connects the mouth to the stomach), potentially damaging the esophagus and causing chronic problems, like regurgitation or vomiting.
    According to a study in The American Journal of Gastroenterology , children with GERD may be at risk for having this condition as an adult, as well. Fortunately, researchers say that detecting and treating GERD during childhood may result in better outcomes later in life.

    What Causes GERD?

    GERD is caused by the weakening of a muscle called the lower esophageal sphincter (LES). When you swallow, it contracts to prevent stomach contents from flowing back up, or regurgitating, into the esophagus. Certain foods, medicines, and conditions can relax the LES, allowing acid to regurgitate.
    If you child has GERD, the doctor may recommend avoiding:
    • Spicy, acidic, or tomato-based foods
    • Fatty or fried foods
    • Citrus products (eg, orange juice)
    • Chocolate
    • Caffeinated drinks (eg, soda, coffee, tea, hot chocolate)
    All teenagers should also avoid smoking cigarettes and drinking alcohol. However, those with GERD have an added incentive, since these activities can worsen their symptoms.
    Gastroparesis , also known as delayed gastric emptying, may also contribute to GERD in children. When the stomach empties too slowly, it may cause bloating, increased acid secretion, and esophagitis (inflammation of the esophagus).

    What Are the Symptoms?

    Symptoms of GERD in children include:
    • Severe abdominal discomfort
    • Lower chest pain
    • Heartburn
    • Sensation of food or liquid regurgitating into the throat or mouth
    • Sensation of food stuck down in the throat
    • Difficulty or pain while swallowing
    • Hoarseness
    • Vomiting
    • Poor weight gain or weight loss
    • Anemia
    • Respiratory problems (eg, wheezing, coughing, pneumonia )
    To help your child communicate how he is feeling and to better understand the symptoms, the Children’s Digestive Health and Nutrition Foundation suggests asking your child the following questions:
    1. Where does your tummy hurt? (Ask your child to point to where it hurts.)
    2. Does it hurt in your chest?
    3. Does it hurt when you eat or drink?
    4. Do you get a yucky or sour taste in your mouth? Does it taste like throw-up?
    5. Does food sometimes get stuck in your throat?

    What Are the Treatment Options?

    GERD can usually be diagnosed based on your child’s symptoms and a physical exam. Additional diagnostic tests are often not required. Once the diagnosis is made, it can be treated through lifestyle changes, medicine, and surgery.

    Lifestyle Changes

    Changing your child’s diet may relieve mild symptoms. Avoiding GERD “trigger” foods may be the first step. The doctor may also suggest feeding your child smaller meals and avoiding food 2-3 hours before bedtime. The doctor may also suggest that you elevate the head of your child's bed 6-8 inches (15-20 centimeters) or have your child sleep on his left side.

    Medication

    Medicines that may be prescribed to treat GERD in children include:
    • H2-blockers—decrease the amount of acid in the stomach (eg, cimetidine [Tagamet HB], famotidine [Pepcid], ranitidine [Zantac])
    • Proton pump inhibitors (PPIs)—decrease the amount of acid in the stomach (eg, omeprazole [Prilosec], lansoprazole [Prevacid])

    Surgery

    Surgery, such as a procedure called fundoplication , is rarely used to treat children with GERD. Rather, it is reserved for severe cases or when medicines and lifestyle changes do not relieve symptoms.

    Take Action Now

    GERD can be an uncomfortable condition for both you and your child. But, there is help available. Recognizing and relieving your child’s symptoms now may benefit his health down the line.

    RESOURCES

    Children’s Digestive Health and Nutrition Foundation http://www.cdhnf.org/

    International Foundation for Functional Gastrointestinal Disorders http://www.aboutgerd.org/

    CANADIAN RESOURCES

    The Canadian Association of Gastroenterology http://www.cag-acg.org/

    Dietitians of Canada http://www.dietitians.ca/

    References

    DynaMed Editorial Team. Gastroesophageal reflux disease (GERD) in infants. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/ . Updated May 5, 2011. Accessed May 20, 2011.

    El-Serag HB, Gilger M, Carter J, et al. Childhood GERD is a risk factor for GERD in adolescents and young adults. Am J Gastroenterol . 2004;99(5):806-812.

    Gastroesophageal reflux. Kids Health website. Available at: http://kidshealth.org/parent/system/surgical/gerd%5Freflux.html# . Accessed May 20, 2011.

    Gastroesophageal reflux (GERD)/acid reflux in infants and children. The Cleveland Clinic website. Available at: http://www.clevelandclinic.org/health/health-info/docs/3600/3642.asp?index=12010&src=news . Accessed October 21, 2005.

    Gastroesophageal reflux in children and adolescents. National Digestive Diseases Information Clearinghouse, National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/gerinchildren/ . Accessed October 17, 2005.

    Gold BD. Gastroesophageal reflux disease: could intervention in childhood reduce the risk of later complications? Am J Med . 2004;117(Suppl 5A):23S-29S.

    Gold BD, Freston JW. Gastroesophageal reflux in children: pathogenesis, prevalence, diagnosis, and role of proton pump inhibitors in treatment. Pediatr Drugs . 2002;4:673-685.

    Hassall E. Decisions in diagnosing and managing chronic gastroesophageal reflux disease in children. J Pediatr . 2005;146(Suppl 3):S3-12.

    Jung AD. Gastroesophageal reflux in infants and children. Am Fam Physician . 2001 Dec 1;64:1853-1860.

    Kay M, Vasundhara T. Common gastrointestinal problems in pediatric patients. American College of Gastroenterology website. Available at: http://www.acg.gi.org/patients/gihealth/pediatric.asp . Accessed October 17, 2005.

    Kellicker P. Gastroesophageal reflux disease—child. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated December 21, 2010. Accessed May 20, 2011.

    Nielsen RG, Bindsley-Jensen C, Kruse-Andersen S, et al. Severe gastroesophageal reflux disease and cow milk hypersensitivity in infants and children: disease association and evaluation of a new challenge procedure. J Pediatr Gastroenterol Nutr . 2004;39(4):383-391.

    Pediatric gastroesophageal reflux: clinical practice guideline summary. Children’s Digestive Health and Nutrition Foundation, North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition website. Available at: http://www.cdhnf.org/pdf/GERD%5F8%5Fpg%5Fbrochure%5F031604.pdf . Accessed October 13, 2005.

    Pediatric GERD: frequently asked questions. Children’s Digestive Health and Nutrition Foundation, North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition website. Available at: http://www.cdhnf.org/faq.html . Accessed October 17, 2005.

    Questions to ask your child about how they feel. Children’s Digestive Health and Nutrition Foundation website. Available at: http://www.cdhnf.org/questions%5Fchild.html . Accessed October 19, 2005.

    Rudolph CD, Mazur LJ, Liptak GS, et al. Guidelines for evaluation and treatment of gastroesophageal reflux in infants and children: recommendations of the North American Society for Pediatric Gastroenterology and Nutrition. J Pediatr Gastroenterol Nutr . 2001;32(Suppl 2):S1-31.

    What you should know about gastroesophageal reflux (GER) in infants and children. American Family Physician website. Available at: http://www.aafp.org/afp/20011201/gastph.html . Accessed October 13, 2005.

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