• Gastroesophageal Reflux Disease in Children With Disabilities

    (GERD—Child With Disabilities; Chronic Heartburn—Child With Disabilities; Reflux Esophagitis—Child With Disabilities; Gastro-oesophageal Reflux Disease—Child With Disabilities; GORD—Child With Disabilities; Heartburn—Child With Disabilities; Reflux—Child With Disabilities)

    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 infants. It causes them to spit up. Most infants 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. Children who have birth defects or disorders of the brain and spine have an increased risk of GERD.
    GERD can cause serious health issues. The sooner it is treated, the better the outcome.
    Gastroesophageal Reflux Disease
    si1347 97870 1 gerd
    Copyright © Nucleus Medical Media, Inc.

    Causes

    GERD is caused by the regular flow of stomach acid into the esophagus. It is not always clear why the acid backs up. The reasons may vary from person to person. There may be a genetic link in some GERD.
    Acid is kept in the stomach by a valve. The valve opens when food comes in. It should close to keep in the food and acid. If 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

    The following factors increase your child’s chance of developing GERD. If your child has any of these risk factors, tell the doctor:

    Symptoms

    If your child has any of these symptoms do not assume it is due to GERD. These symptoms may be caused by other health conditions. If your child has any one of them, see the doctor.
    • Difficulty swallowing or choking with feedings
    • Apnea or blue spells (called cyanosis), when not enough blood gets to the lungs
    • Refusal to eat
    • Increased mouth secretions
    • Regurgitation or vomiting
    • Bloody vomit
    • Weight loss or poor weight gain
    • Pain in the abdomen or chest
    • Recurrent pneumonia or respiratory problems
    • Coughing or wheezing
    • Hoarseness
    • Arching back while feeding
    • Irritability or restlessness while feeding

    Diagnosis

    Your doctor will ask about your child's symptoms and medical history. A physical exam will be done. Your child may need to see a special doctor. The doctor may specialize in disorders of the stomach and intestines.
    To help diagnose GERD, your doctor may ask for some of the following tests:
    • Swallowing evaluation—an occupational therapist will evaluate your child’s ability to swallow
    • Upper GI series —x-rays of the esophagus and stomach are take after drinking a special solution
    • Upper endoscopy with biopsy—a tube is inserted into esophagus to look at the lining and take a sample of the tissue
    • 24-hour pH monitoring—a probe is placed in the esophagus to keep track of the acid levels
    • Nuclear medicine scan—images are taken with the help of special radioactive material to see if the stomach is working well or if fluid is in the lungs

    Treatment

    There are three goals for treatment. The first is to prevent injury to the esophagus. The second is to make sure the child is eating enough. The third goal is to keep the backed up food and acid from getting into the lungs. This will require a team approach. Your child may work with the pediatrician, specialized doctors, and a variety of therapists.
    Talk with your doctor about the best treatment plan for your child. Treatment options include:

    Feeding Management

    It is important that your child is able to get the food needed for good health. GERD can make it difficult for your child to eat. Your doctor may recommend a feeding tube . This is a tube that is inserted through your child's nose to your child’s stomach. It will deliver the nutrients your child needs. The feeding tube will also decrease the risk of choking and ease the stress of feeding.

    Medications

    Most GERD in children can be relieved with lifestyle changes. Medication may be given if your child's GERD doesn't improve. The medication can help to decrease acid in the stomach and help the esophagus heal. Medication options may include:
    • Histamine-2 receptor drugs—such as Pepcid, Axid, Zantac
    • Proton pump inhibitors—such as Prilosec, Prevacid, Protonix, Nexium
    Many of these are available in liquid or powder form.

    Procedures

    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

    While the cause of GERD is largely unknown, you can take steps to control the condition in your child by:
    • Keeping the medical team informed of changes in your child's health.
    • Learning how to care and use the feeding tube.
    • Keeping a diary of your child's symptoms and progress.

    RESOURCES

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

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

    CANADIAN RESOURCES

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

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

    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 in children and adolescents. National Digestive Diseases Information Clearinghouse website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/gerinchildren/index.htm . Accessed July 30, 2012.

    Gastroesophageal reflux disease (GERD). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated July 2012. 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 and gastroesophageal reflux disease in the neurologically impaired child. Children’s Digestive Health and Nutrition Foundation website. Available at: http://gerd.cdhnf.org/User/Docs/PDF/NERO%5FBrochure.pdf . 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.

    Revision Information

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