Pediatric Gastroesophageal Reflux: Practice Essentials, Background, Etiology and Pathophysiology

Cow’s milk protein elimination advice was implemented and by the age of 10 months James’ weight and length had returned to the 25th percentile. At 18 months of age James was re-challenged with cow’s milk, with no recurrence of symptoms.

This is for safety reasons and to reduce the risk for SIDS and other sleep-related infant deaths. Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.

What are the symptoms of GERD?

However, when digestive disturbances in children become more frequent, it’s a good time to seek an opinion from a medical professional. If these don’t help and your child still has severe symptoms, then surgery might be an option.

In older children, it is worthwhile to maintain a dietary journal to help identify GERD and food relationships. Carbonated or caffeinated beverages may be associated with GERD. In some cases, medications may be indicated.

Antisecretory treatment for pediatric gastroesophageal reflux disease – a systematic review. Regurgitation and gastro-oesophageal reflux disease (GORD) usually begin before the age of 8 weeks and resolve before 1 year of age in 90% of infants [National Collaborating Centre for Women’s and Children’s Health, 2015].

These babies often get sleepy after they eat or drink a little. Other babies vomit after having a normal amount of formula. These babies do better if they are constantly fed a small amount of milk. In both of these cases, tube feedings may be suggested. Formula or breastmilk is given through a tube that is placed in the nose.

Formula or breast milk is given through a tube that is placed in the nose, guided through the esophagus, and into the stomach (nasogastric tube). Nasogastric tube feedings can be given in addition to or instead of what a baby takes from a bottle. Nasoduodenal tubes can also be used to bypass the stomach.

  • Infants with reflux should be fed in an upright or semi-upright position and then maintained in an upright, nonsitting position for 20 to 30 minutes after eating (sitting, as in an infant seat, increases stomach pressure and is not helpful).
  • These babies do better if they are constantly fed a small amount of milk.
  • Medications.
  • Proton pump inhibitors are reasonable treatment options for GERD in older children and adolescents, but their use in infants is questionable because of a lack of proven effectiveness.

If the esophagus is significantly irritated (esophagitis), there may be some bleeding, resulting in iron deficiency anemia. In others, esophagitis can cause scar tissue, which can narrow the esophagus (stricture). There are very cases where children whose GERD is so severe that a surgical procedure must be considered to manage symptoms. The procedure, called a Nissen fundoplication, involves wrapping the top part of the stomach around the lower esophagus.

Endoscopy is performed to determine if there is inflammation of the esophagus or stomach and to determine if there is an underlying cause of the reflux. During an endoscopy, a tiny camera is passed through a child’s digestive system and down into the stomach to look at the inside of these organs.

Children younger than age 12 will often have different GERD symptoms. They will have a dry cough, asthma symptoms, or trouble swallowing. They won’t have classic heartburn. If a child or teen has gastroesophageal reflux (GER), he or she may taste food or stomach acid in the back of the mouth. The major pharmacologic agents currently used for treating GERD in children are gastric acid-buffering agents, mucosal surface barriers, and gastric antisecretory agents.

The end of the tube inside the esophagus contains a sensor that measures pH, or acidity. The other end of the tube outside the body is connected to a monitor that records the pH levels for a 24- to 48-hour period. Normal activity is encouraged during the study, and a diary is kept of symptoms experienced, or activity that might be suspicious for reflux, such as gagging or coughing.

Gastric emptying study. This test is done to see if your child’s stomach sends its contents into the small intestine properly. Delayed gastric emptying can cause reflux into the esophagus. Esophageal manometry. This test checks the strength of the esophagus muscles.

The major role of history and physical examination in the evaluation of purported GERD is to rule out other more worrisome disorders that present with similar symptoms (especially vomiting) and to identify possible complications of GERD. The vast majority of spitting and crying infants suffer from physiologic GER (also called infant regurgitation), a benign condition with an excellent prognosis, needing no intervention except for parental education and anticipatory guidance, and possible changes on feeding composition. Overfeeding exacerbates recurrent regurgitation [6].

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