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Gastroesophageal Reflux in Children and Adolescents

With GER, reflux can happen during or after a meal. In some children, stomach contents go up into the mouth and are swallowed again. Gastroesophageal reflux disease (GERD) happens when reflux of stomach contents causes problems or symptoms. Complications include weight loss or not enough weight gain, irritability, feeding refusal, hoarse voice, repeat pneumonias, cough, wheezing, and difficulty breathing or swallowing.

How Common is Gastroesophageal Reflux?

GER is common in babies. But only a small number of infants continue to have GER as they get older. If a child continues to have symptoms of GER, they should be evaluated by their pediatrician.

What Causes Gastroesophageal Reflux?

There is a ring of muscle at the bottom of the esophagus that opens and closes. This allows food to enter the stomach. This ring is called the lower esophageal sphincter (LES). Reflux happens when the LES opens. At this time, some stomach contents and acid come back up into the esophagus. Almost all children and adults have some reflux, without being aware of it.

When refluxed material quickly returns to the stomach, it does not cause damage to the esophagus. In some children, reflux happens often or does not clear. This can cause damage to the esophagus. When the refluxed material goes into the back of the mouth or the airways, the child may become hoarse, have a raspy voice, or a chronic cough.

How is Gastroesophageal Reflux Diagnosed?

The doctor or nurse will talk with you about your child's symptoms, do a physical exam, and may recommend tests to see if reflux is the cause of symptoms. Treatment is sometimes started without the need for any tests.

The Upper GI Series X-Ray

Barium (a chalky drink) is swallowed, and then an X-ray is taken. X-rays show the shape of the esophagus and stomach. This test can find a hiatal hernia, blockage and other problems that might look like reflux.

Endoscopy

After the patient is given a medication to fall asleep, a small flexible tube with a tiny camera is put in the mouth and down into the esophagus and stomach. The lining of the esophagus, stomach and small intestine can be seen. Biopsies (small pieces of the lining) can be taken. The biopsies can be looked at with a microscope to look for inflammation and other problems.

Esophageal pH Probe

A thin, light wire with an acid sensor is put through the nose into the lower part of the esophagus. The probe detects and records the amount of stomach acid coming back up into the esophagus when the child has symptoms.

How is Gastroesophageal Reflux Treated?

The treatment of reflux depends upon the child's symptoms and age. When a child or teenager is uncomfortable and has difficulty sleeping, eating or growing, the doctor or nurse may suggest trying medication. These medicines are used to decrease the amount of acid made in the stomach.

If the child continues to have symptoms despite the initial treatment, the doctor or nurse may order one of the tests described above to help find treatments that could work better. It is rare for children to need surgery for GER.

Your child's doctor or nurse can discuss the treatment options with you and help your child feel well again.