Spit Happens – Gastroesophageal Reflux in Pediatrics

Gastroesophageal reflux (GER), defined as passage of gastric contents into the esophagus, and GER disease (GERD), defined as symptoms or complications of GER, are common pediatric problems encountered by both primary and specialty medical providers. Clinical manifestations of GERD in children include vomiting, poor weight gain, dysphasia, abdominal or substantial pain, esophagitis, and respiratory disorders.

Reflux and your baby (0-24 month olds)                         

Gastroesophageal reflux (GER) occurs during or after a meal when stomach contents go back into the tube that connects the mouth to the stomach. GER occurs often in normal infants. Most infants with GER are happy and healthy even though they spit up or vomit. Spitting up tends to peak at 4 months and most infant stop spitting up by 12 months of age.

If your baby is spitting up without discomfort and is making appropriate weight gains, then he or she is probably a normal spitter.

Worrisome symptoms of reflux disease in infants (0-24 months old)

  1. Vomiting associated with
    • Blood
    • Green or yellow fluid
    • Poor weight gain
    • Poor growth or failure to thrive
    • Difficulty eating
  2. Inconsolable or severe crying and irritability
  3. Persistent food refusal
  4.  Breathing problems
    • Difficulty breathing
    • Repeat bouts of pneumonia
    • Breathing stops
    • Turning blue
    • Chronic cough
    • Wheezing

If you have concerns, speak to your health care provider. Most babies outgrow reflux by one year of age.

Diagnosis

Is made usually by history, but there are tests that can be done in severe cases, such as:

  • Barium swallow or upper GI series. This is a special x-ray test that uses barium to highlight the esophagus, stomach, and upper part of the small intestine.
  • PH probe. Measures levels of stomach acids. It also helps determine if breathing problems are the result of reflux.
  • Upper GI endoscopy. This is done using an endoscope (a thin, flexible, lighted tube and camera) that allows the doctor to look directly inside the esophagus, stomach, and upper part of the small intestine.

Treatment

For infants:

-Elevating the head of the baby’s crib or bassinet

-Holding the baby upright for 30 minutes after the feeding

-Thickening bottle feedings with cereal (do not do this without a doctor’s supervision)

-Changing feedings schedule

-Trying solid food (with your doctor’s approval)

For older children:

-Elevating the head of the child’s bed

-Keeping the child upright for at least 2 hours after eating

-Serving several small meals throughout the day, rather than 3 large meals

-Limiting foods and beverages that seem to worsen the child’s reflux

-Encouraging your child to get regular exercise

If the reflux is severe or doesn’t get better, your doctor may recommend drugs to treat it.

Drugs to Lessen gas

  • Mylicon
  • Gaviscon

Drugs to Neutralize or Decrease Stomach Acid

  • Antacids such as Mylanta and Maalox
  • Histamine-2(H2) blockers such as Axid, Pepcid,Tagament,or Zantac
  • Proton- pump inhibitors such as Nexium, Prilosec, Prevacid, Aciphex, and Protonix