Gastroesophageal Reflux Disease (GERD) / Heartburn

This is a chronic digestive disorder that is caused by the abnormal flow of gastric acid from the stomach into the esophagus. GER is very common in infants, it can occur at any age. it is the most common cause of vomiting during infancy.

What causes GERD? 

  • GERD is often the result of conditions that affect the lower esophageal sphincter (LES). The LES, a muscle located at the bottom of the esophagus, opens to let food into the stomach and closes to keep food in the stomach. When this muscle relaxes too often or for too long, acid refluxes back into the esophagus, causing vomiting or heartburn

Some foods seem to affect the muscle tone of the lower esophageal sphincter, allowing it to stay open longer than normal. These include, but are not limited to, the following

  • chocolate
  • peppermint
  • high-fat foods
Other foods increase acid production in the stomach, including

  • citrus foods
  • tomatoes and tomato sauces

Why is Gerd a concern?

Some infants and children who have GER may not vomit, but may still have stomach contents move up the esophagus and spill over into the windpipe, which can cause asthma and/or pneumonia. Infants and children with GERD who vomit frequently may not gain weight and grow normally. These can be painful and also may bleed, leading to anemia. Esophageal narrowing and Barrett's esophagus are long-term complications from inflammation that are seen in adults.

What are the symptoms of GERD?

  • belching
  • refusal to eat
  • stomachaches 
  • fussiness around mealtimes
  • frequent vomiting 
  • hiccups
  • gagging
  • chocking
  • frequent cough
  • coughing fits at night
  • wheezing 
  • frequent upper respiratory infections
  • frequent ear infections
  • rattling in the chest
  • frequent sore throats in the morning
  • sour taste in the mouth

How is GERD diagnosed?

  • chest x-ray - A diagnostic test to look for evidence aspiration -- the movement of stomach contents into the lungs.
  • Upper GI (gastrointestinal) series - A diagnostic test that examines the organs of the upper part of the digestive system, the esophagus, stomach, and duodenum. A fluid called barium is swallowed. X-rays are then taken to evaluate the digestive organs for evidence of ulceration or abnormal blockages.
  • Endoscopy - A test that uses a small, flexible tube with a light and a camera lens at the end to examine the inside of part of the digestive tract.
  • Esophageal manometric study - A test that helps determine the strength of the muscles in the esophagus.
  • pH monitoring - To measure the acidity inside of the esophagus. It is helpful in evaluating the extent of GERD.
  • Gastric emptying study - A test designed to determine if the stomach releases its contents into the small intestine properly. Delayed gastric emptying can contribute to reflux into the esophagus.

Treatment for GERD

  • your child's age, overall health, and medical history
  • extent of the disease
  • the expectations for the course of the disease
  • your opinion or preference
In many cases, GERD can be relieved through diet and lifestyle changes. Some ways to better manage GERD symptoms include the following

  • ask your child's doctor to profile any of the medications he or she is taking--some may irritate the lining of the stomach or esophagus.
  • limit fried and fatty foods, peppermint, chocolate, drinks with caffeine (such as colas, Mountain Dew, and tea), citrus fruit and juices, and tomato products.
  • offer your child smaller portions at mealtimes, and include small snacks in-between meals if your child is hungry. Avoid letting your child overeat.
  • if your child is overweight, consult his or her doctor to set weight loss goals.
  • do not allow your child to lie down or go to bed right after a meal. Serve the evening meal early--at least two hours before bedtime.
  • after feedings, hold your infant in an upright position for 30 minutes.
  • ff bottle-feeding, keep the nipple filled with milk so your infant does not swallow too much air while eating.
  • Adding rice cereal to feeding may be beneficial for some infants.
  • Burp your baby several times during bottle-feeding or breastfeeding. Your child may reflux more often when burping with a full stomach.

What is the long-term outlook for a child with GERD?

Many infants who vomit will "outgrow it" by the time they are about a year old, as the lower esophageal sphincter becomes stronger. For others, medications, lifestyle, and diet changes can minimize reflux, vomiting, and heartburn.