Acid reflux Not Just for Adults
In infants, more than 50 percent of children three months or younger have at least one episode of regurgitation a day. This rate peaks at 67 percent at age four months. An infant's improved neuromuscular control and the ability to sit up will lead to the spontaneous resolution of significant GER in more than half of infants by age 10 months and four out of five at age 18 months.
Researchers have found that 10 percent of infants younger than 12 months with GER develop significant complications.
The diseases associated with reflux are known collectively as Gastro-Esophageal Reflux Disease (GERD). Physically, GERD occurs when a muscular valve at the lower end of the esophagus malfunctions. Normally, this muscle closes to keep acid in the stomach and out of the esophagus. The continuous entry of acid or refluxed materials into areas outside the stomach can result in significant injury to those areas.
It is estimated that some five to eight percent of adolescent children have GERD.
Children with reflux experience relatively few symptoms until the problem shifts to GERD with symptoms of heartburn. Adults frequently complain about heartburn, but children have a harder time describing this sensation. They usually will complain of a stomach ache or chest discomfort, particularly after meals.
More frequent or severe GER and EER can cause other problems in the stomach, esophagus, pharynx, larynx, lungs, sinuses, ears and even the teeth. Consequently, additional symptoms may include crying, irritability, poor appetite, feeding and swallowing difficulties, weight loss, regurgitation, stomach aches, abdominal or chest pain, sore throat, hoarseness, apnea, laryngeal and tracheal stenoses, asthma and wheezing, chronic sinusitis, ear infections, and dental caries.
Effortless regurgitation is very suggestive of GER. However, recurrent vomiting (which is not the same) does not necessarily mean a child has GER. This is usually a diagnosis thought of when other more likely possibilities are ruled out.
Unlike infants, the adolescent child will not necessarily resolve GERD on his or her own. If your child displays the typical symptoms of GERD, a visit to a pediatrician is warranted. When the disorder causes significant ear, nose, and especially throat problems, an evaluation by an ear-nose-throat physician is recommended.
To diagnose GERD in children, the caregiver is interviewed, examine the child, and may recommend some of the following tests:
- pH probe: A small wire with an acid sensor is placed through the nose down to the bottom of the esophagus. The sensor can detect when acid from the stomach is "refluxed" into the esophagus. This information is generally recorded on a computer. Usually, the sensor is left in place between 12 and 24 hours. Results will indicate how often the child "refluxes" acid into his or her esophagus and whether he or she has any symptoms when that occurs.
- Barium swallow or upper GI series: The child is fed barium, a white, chalky, liquid. A video x-ray machine follows the barium through the upper intestinal tract and lets doctors see if there are any abnormal twists, kinks or narrowings of the upper intestinal tract.
- Technetium gastric emptying study: The child is fed milk mixed with technetium, a very weakly radioactive chemical, and then the technetium is followed through the intestinal tract using a special camera. This test is helpful in determining whether some of the milk/technetium ends up in the lungs (aspiration). It may also be helpful in determining how long milk sits in the stomach.
- Endoscopy with biopsies: This most comprehensive test involves the passing down of a flexible endoscope with lights and lenses through the mouth into the esophagus, stomach, and duodenum. This allows me to get a direct look at the esophagus, stomach, and duodenum and see if there is any irritation or inflammation present. In some children with gastroesophageal reflux, repeated exposure of the esophagus to stomach acid causes some inflammation (esophagitis). Endoscopy in children usually requires an anesthetic and is usually performed by a gastroenterologist.
- Fiberoptic Laryngoscopy: A small lighted scope is placed in the nose and the pharynx to evaluate for inflammation of the lower throat and voice box.
Steps to help older children with GERD include:
- Lifestyle changes: Raise the head of the child's bed about 30 degrees while they sleep and have the child eat smaller, more frequent meals instead of large amounts of food at one sitting. Avoid having the child eat right before they go to bed or lie down; instead, let two or three hours pass. Try a walk or warm bath.
- Dietary changes: Avoid chocolate, carbonated drinks, caffeine, tomato products, peppermint, and other acidic foods as citrus juices. Fried foods and spicy foods are also known to aggravate symptoms. Pay attention to what your child eats and be alert for individual problems.
It is rare for children with GERD to require surgery. For the few children who do, the most commonly performed operation is called Nissen fundoplication. With this procedure, the top part of the stomach, the fundus, is wrapped around the bottom of the esophagus to create a collar. After the operation, every time the stomach contracts, the collar around the esophagus contracts preventing reflux.
If you think your child may have GERD, schedule an appointment. Treatment will make life more pleasant for your child — and you.
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