All babies spit up at one point or another. It’s a natural occurrence, and for some, can happen quite frequently. So how do parents know if their child’s symptoms are normal or part of a larger issue? To answer this question, we asked Edgardo Rivera-Rivera, MD, PPG – Pediatric Gastroenterology, to explain what Gastroesophageal Reflux Disease (GERD) is and when parents should be concerned.
What is pediatric Gastroesophageal Reflux Disease (GERD)?
To understand this digestive disorder, let’s first examine the difference between Gastroesophageal Reflux (GER) and Gastroesophageal Reflux Disease (GERD). GER occurs when gastric secretions like saliva, gastric juices, bile or food pass into the esophagus. This condition is common in babies between two and six months old but can happen at any age. GERD is a more severe form of GER, and it is diagnosed when the reflux is present alongside other symptoms or complications.
What causes pediatric GERD?
There are four main reasons why pediatric patients, particularly babies, are at an increased risk for reflux:
- Anatomical: Babies have a shorter esophagus and smaller stomach compared to adults. Because of this, food and liquids tend to come back up much easier than they would for an adult.
- Physiological: Children usually have a slower gastric emptying than adults, meaning their stomachs don’t empty as fast. So, the stomach contents will remain for longer, making it easier for reflux to occur.
- Dietary: Infants often drink formula or breast milk the entire day, and because liquids are easier to spit up than solids, they are at an increased risk for reflux.
- Positional: Because infants and babies sleep so much in the first several months, they are often lying flat on their backs, preventing gravity from keeping their stomach contents down.
What are the signs and symptoms of pediatric GERD?
The signs and symptoms of pediatric GERD can vary by age. Typically, the symptoms you're going to see in infants aren’t going to be the same in older children or adolescence. In infants, the most common signs of reflux could include:
- An increase in foamy salivation
- Pain and irritability with feedings
- Refusal to feed altogether
- Difficulty breathing
Fortunately, older children have the luxury of being able to explain their discomfort and talk about their symptoms. Common signs and symptoms of reflux in older children and adolescents could include:
- Burning or pain in the chest (heartburn)
- A feeling of food or stomach acid coming up their throat
- Nausea or vomiting
- Frequent coughing, wheezing or hoarseness
- Pain, discomfort or difficulty swallowing
- Frequent ear infections or sinusitis
- Pain that worsens when lying down
Other red flag symptoms that parents and caregivers should watch for include waking in the middle of the night with symptoms, unintentional weight loss, and nausea or vomiting that doesn’t resolve.
Are there certain foods that affect pediatric GERD more than others?
Yes, there are three main food categories that patients, particularly older children and adolescents, experiencing GERD should avoid. They include:
- Spicy food like chili, salsa and hot peppers
- Acidic food such as pickles, citrus fruit and juices, ketchup or tomato-based foods
- Fatty, greasy or deep-fried food like French fries, pizza or burgers
Other foods that may aggravate GERD could also include carbonated drinks, chocolate or caffeine.
How is the digestive disorder diagnosed?
Pediatric GERD is clinically diagnosed. We will obtain a medical history from the patient, perform a physical exam, assess and review the child’s symptoms and ask any necessary follow up questions. Then, based on the answers and our findings, we can make a diagnosis.
How is pediatric GERD treated?
For infants, we try to incorporate reflux precautions into their everyday routine. Parents and caregivers can start by:
- burping the baby after every feeding
- making sure not to overfeed the baby
- elevating the head of the child’s crib or bassinet
- removing the baby from their car seat when outside of the car to avoid prolonged time spent in the safety seat
If the infant’s symptoms persist even after reflux precautions, we will investigate possible medication options for the child.
For older children, who can more easily express their discomfort and be more vocal about their symptoms, we initially examine the food they are consuming. If we notice their diet isn’t the best, and they are eating food that will increase the chance for reflux, we start with dietary modifications before moving to medication or other treatment forms.
Is there anything parents or caregivers can do to prevent the disorder?
Yes, there are actions parents and caregivers can take, but first, I want to mention that some infants and babies are just prone to reflux. They can have the best diet in the world, and parents can be doing everything right, but sometimes it’s just the way the child’s body works. With that said, parents can utilize the above-mentioned reflux precautions for infants and diet modifications for older children to help prevent the occurrence or recurrence of reflux. Taking these steps can prove to be quite impactful, and in time pediatric GERD will usually resolve with proper treatment, lifestyle, and dietary modifications.
When should parents call their child’s healthcare provider?
Parents and caregivers should call their child’s healthcare provider if they notice the reflux symptoms are persisting despite dietary and lifestyle modifications. If the condition worsens even after medical intervention by a primary care provider, parents may be referred to or need to reach out to a pediatric gastroenterologist.
Final thoughts
Don’t be afraid to ask questions or seek help if your child is exhibiting reflux signs or complaining of discomfort. Parents must be attentive and vigilant with their child’s symptoms and condition. Remember, early detection, diagnosis and treatment are key in avoiding future complications and health issues.
