The common gastroesophageal reflux (GER), or acid reflux, is normal, and babies usually outgrow it by 1 or 2 years old. GERD is the more serious form. It’s the most common disorder of the esophagus in children of all ages, especially in premature children and in children with other disorders such as cerebral palsy. The esophagus is the tube that connects the mouth with the stomach. In GERD, the muscle that stops food from returning to the esophagus from the stomach doesn’t work well and stomach contents may move in the wrong direction back into the esophagus (“reflux”). reflux that occurs more than twice a week is GERD and can lead to serious health problems.
GERD most often occurs in babies with immature digestive tracts. Other causes include anatomic problems of the esophagus and other structures such as hernias, certain medicines, and neurodevelopmental disabilities.
Common symptoms in babies are regurgitation and vomiting. Regurgitation (“spitting up”) is return of undigested food back up the esophagus into the mouth, without the force of vomiting. Other symptoms are crying and irritability, arching of the back, breathing problems, refusing food, and failure to thrive. Children may have pain in the abdomen (belly) or heartburn after meals, nausea, coughing, trouble swallowing, asthma, sore throat, ear pain, unhealthy teeth, bad breath, and hoarseness.
The health care provider uses a medical and dietary history and physical examination for diagnosis. Other studies are for more serious or unusual symptoms. These studies include X-rays (upper gastrointestinal, or GI, series), endoscopy, and esophageal pH monitoring.
Treatment goals are to reduce symptoms, heal the esophagus, and prevent complications. Babies with GERD need lifestyle changes, including thickened formula or breast milk, smaller and more frequent feedings, frequent burping, and keeping upright for longer periods (30 minutes) after feedings. Older children should eat small, frequent meals. Foods to avoid are caffeine-containing sodas; chocolate; peppermint; spicy foods; acidic foods such as oranges, tomatoes, and pizza; and fried and fatty foods. Not eating for 2 to 3 hours before bed may help. Raising the head of the child’s bed may work. Weight management of overweight or obese children is important. If these treatments don’t work or if children develop serious illnesses, medicines or surgery can be tried. Medicines include antacids, H2-receptor antagonists (such as ranitidine), and proton pump inhibitors (such as omeprazole).
Antireflux surgery is one of the most common procedures done for babies and young children, but it’s the last resort because it includes risks.
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