311801 Health Library | Health and Wellness | Wellmont Health System
  • Gastroesophageal Reflux Disease—Infant

    (GERD—Infant; Chronic Heartburn—Infant; Reflux Esophagitis—Infant; Gastro-oesophageal Reflux Disease—Infant; GORD—Infant; Heartburn—Infant; Reflux—Infant)

    Definition

    Gastroesophageal reflux (GER) is a back up of acid or food from the stomach to the esophagus. The esophagus is the tube that connects your mouth and stomach. GER is common in babies. It causes them to spit up. Most babies outgrow GER within 12 months.
    GER that continues after 18-24 months may be gastroesophageal reflux disease (GERD). GERD is pain and swelling in the esophagus. It is caused by the regular flow of acid to the esophagus. GERD can cause serious health issues. The sooner it is treated, the better the outcome.
    Gastroesophageal Reflux Disease
    EC00059 97870 1 gerd stomach
    Food and acid back up into the esophagus from the stomach.
    Copyright © Nucleus Medical Media, Inc.

    Causes

    GERD is caused by stomach acid that regularly backs up into the esophagus. It is not always clear why the acid backs up. The reasons may also vary from person to person. There may be a genetic link in some GERD.
    Acid is kept in the stomach by a valve at the top of the stomach. The valve opens when food comes in. It should close to keep in the food and acid. When this valve does not close properly, the acid can flow out of the stomach. The valve may not close because of:
    • Problems with the nerves that make the valve open or close
    • Increased pressure in the stomach—such as too much food in the stomach or pressure on the abdomen
    • Irritation in the stomach or muscles of the valve
    • Problem with the valve itself

    Risk Factors

    Factors that may increase your child's risk of GERD include:

    Symptoms

    GER is very common in the first year of life. If GER symptoms worsen or don’t improve by 18 months, ask the doctor to re-evaluate your baby.
    If your baby has any of these symptoms, do not assume it is due to GERD. These symptoms may be caused by other conditions. If your baby has any of these, tell the doctor:
    • Spitting up or vomiting
    • Not growing or gaining weight
    • Refusal to feed or difficulty feeding
    • Irritability or fussiness during or after feeding
    • Arching of back or other movements during or after feeding
    • Regurgitation or bloody vomit
    • Breathing problems
    • Difficulty swallowing
    • Recurrent pneumonia or respiratory problems
    • Apnea or blue spells (called cyanosis), when not enough blood gets to the lungs
    • Cough or wheezing
    • Hoarseness
    • Disturbed sleep
    • Excessive crying

    Diagnosis

    Your doctor will ask about your baby’s symptoms and medical history. A physical exam will be done. Your baby may need to see a pediatric gastroenterologist. This is a doctor who focuses on problems of the stomach and intestines.
    Tests may include:
    • Upper GI series —a series of x-rays of the stomach and esophagus after drinking a special solution
    • Upper endoscopy with biopsy—a tube is inserted down throat to look at the esophagus and take a piece of tissue for testing
    • 24-hour pH monitoring—a probe is placed in the esophagus to keep track of the acid in the lower esophagus
    • Short trial of medicine—success or failure of medication may help your doctor understand the cause

    Treatment

    Talk with your doctor about the best treatment plan for your child. Treatment options include the following:

    Lifestyle Changes

    Lifestyle change can help improve symptoms. Your doctor may suggest these lifestyle changes:
    • Try a hypoallergenic formula for one to two weeks. This formula has removed items linked with common allergic reactions.
    • Provide small, frequent feedings
    • Thicken your baby’s formula or milk. Use rice, cereal or other thickening agent.
    • Use a different pre-thickened formula.
    • Burp your baby more often. For example, burp your baby every one to two hours after being fed.
    • Make sure your baby is in an upright position during feeding. Keep your baby upright for 30 minutes after being fed.
    • Keep a diary of your baby's symptoms.
    • Ask your doctor about sleeping positions. These positions depend on your baby's age. Young babies should always be placed on their back because of the risk of sudden infant death syndrome .
    • Keep your baby away from second-hand smoke.
    Lifestyle change can help improve symptoms. Your doctor may suggest these lifestyle changes:
    • Try a hypoallergenic formula for one to two weeks. This formula has removed items linked with common allergic reactions.
    • Provide small, frequent feedings
    • Thicken your baby’s formula or milk. Use rice, cereal or other thickening agent.
    • Use a different pre-thickened formula.
    • Burp your baby more often. For example, burp your baby every one to two hours after being fed.
    • Make sure your baby is in an upright position during feeding. Keep your baby upright for 30 minutes after being fed.
    • Keep a diary of your baby's symptoms.
    • Ask your doctor about sleeping positions. These positions depend on your baby's age. Young babies should always be placed on their back because of the risk of sudden infant death syndrome .
    • Keep your baby away from second-hand smoke.

    Medications

    In most cases, treatment starts with making lifestyle changes. Medication may be given if your baby's GERD doesn't improve. The medication can help to decrease acid in the stomach and help the area heal. Medication options may include:
    • Histamine-2 receptor drugs—such as Pepcid, Axid, Zantac
    • Proton pump inhibitors—such as Prilosec, Prevacid, Protonix, Nexium

    Surgery

    Surgery or endoscopy may be recommended with more severe cases.
    The most common surgery is called fundoplication . During this procedure, a part of the stomach will be wrapped around the stomach valve. This makes the valve stronger. It should prevent stomach acid from backing up into the esophagus. This surgery is often done through small incisions in the skin, called laparoscopy .

    Prevention

    The cause of GERD is largely unknown. You can take steps to control GER in your baby by:
    • Following the lifestyle and dietary changes.
    • Keeping your baby away from second-hand smoke.
    • Keeping a diary of your baby's symptoms

    RESOURCES

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

    National Digestive Diseases Information Clearinghouse (NDDIC) http://digestive.niddk.nih.gov/index.htm

    CANADIAN RESOURCES

    About Kids Health http://www.aboutkidshealth.ca

    Canadian Digestive Health Foundation http://www.cdhf.ca/index.html

    References

    Dente K. Quick lesson about gastroesophageal reflux disease in children and adolescents. EBSCO Nursing Reference Center website. Available at: http://www.ebscohost.com/pointOfCare/nrc-about . Accessed July 30, 2012.

    Gastroesophageal reflux disease in infants. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated June 22, 2012. Accessed July 30, 2012.

    Gastroesophageal reflux in infants. National Digestive Diseases Information Clearinghouse website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/gerdinfant/index.htm . Accessed July 30, 2012.

    GERD in children with an underlying structural anomaly. Children’s Digestive Health and Nutrition Foundation website. Available at: http://gerd.cdhnf.org/User/Docs/PDF/CUSA%5FBrochure.pdf . Accessed July 30, 2012.

    Pediatric gastroesophageal reflux, clinical practice guideline summary. Children’s Digestive Health and Nutrition Foundation website. Available at: http://gerd.cdhnf.org/User/Docs/PDF/GERD%5F8%5Fpg%5Fbrochure%5F031604.pdf .Accessed July 30, 2012.

    Pediatric GE reflux clinical practice guidelines. J Pediatr Gastroenterol Nutr. 2001;32:S1-S31.

    1/6/2009 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Orenstein SR, McGowan JD. Efficacy of conservative therapy as taught in the primary care setting for symptoms suggesting infant gastroesophageal reflux. J Pediatr. 2008;152:310-314. Epub 2007 Nov 7.

    Revision Information

    • Reviewer: Michael Woods
    • Review Date: 09/2012
    • Update Date: 00/92/2012
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