Frequent effortless regurgitation of feeds is common and normal in infants younger than 1 year of age. It may be difficult to differentiate between gastro-oesophageal reflux (GOR) and gastro-oesophageal reflux disease (GORD) as there is no reliable diagnostic test. This CKS topic covers the diagnosis, assessment, and management of gastro-oesophageal reflux disease (GORD) in children younger than 2 years of age. A small percentage of infants who have very frequent or forceful spitting up, crying, coughing, distress, or weight loss, may actually have GERD or another condition. GERD is more common in children who are 2-3 years of age or older.
Medicines and other treatments
The major role of history and physical examination in the evaluation of purported GERD is to rule out other more worrisome disorders that present with similar symptoms (especially vomiting) and to identify possible complications of GERD. The vast majority of spitting and crying infants suffer from physiologic GER (also called infant regurgitation), a benign condition with an excellent prognosis, needing no intervention except for parental education and anticipatory guidance, and possible changes on feeding composition. Overfeeding exacerbates recurrent regurgitation .
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. Many infants who spit up milk have no complications and “outgrow it” after a year. Most cases of reflux will be uncomplicated GER. If feeding and positional changes do not improve GERD, and the infant still has problems with feeding, sleeping, and growth, a doctor may recommend medications to decrease the amount of acid in the infant’s stomach.
Inconsolable crying, refusing food, crying for food and then pulling off the bottle or breast only to cry for it again, failure to gain adequate weight, bad breath, and burping are also common. Children may have one symptom or many; no single symptom is universal in all children with GERD. these causes include bloating, gas, colitis, endometriosis, food poisoning, GERD, IBS (irritable bowel syndrome), ovarian cysts, abdominal adhesions, diverticulitis, Crohn’s disease, ulcerative colitis, gallbladder disease, liver disease, and cancers. The use of these medications follows a stepwise approach (from #1 to #4) based upon severity of symptoms.
The fairly rapid tachyphylaxis that develops with H 2 RAs is a major drawback to their chronic use. The occurrence of tachyphylaxis, or a decrease of the response, to intravenous ranitidine and the escape from its acid-suppressive effect have been observed after 6 weeks , and tolerance to oral H 2 RAs in adults is well recognized [84, 85]. In some infants, H 2 RA therapy causes irritability, head banging, headache, somnolence, and other side effects that, if interpreted as persistent symptoms of GERD, could result in an inappropriate increase in dosage .
The end of the tube inside the esophagus contains a sensor that measures pH, or acidity. The other end of the tube outside the body is connected to a monitor that records the pH levels for a 24- to 48-hour period. Normal activity is encouraged during the study, and a diary is kept of symptoms experienced, or activity that might be suspicious for reflux, such as gagging or coughing.
Do not give aspirin to anyone younger than 20. It has been linked to Reye syndrome, a serious illness. Limit foods that might make reflux worse. These include chocolate, sodas that have caffeine, spicy foods, fried foods, and high-acid foods such as oranges and tomatoes. An esophageal pH test, which measures how much acid is in the esophagus.
- In rare cases, a child may need surgery.
- The barium coats the esophagus and stomach and makes it show up on the x-ray.
- When this valve opens or closes at the wrong time, this may cause symptoms of GERD.
- If a child or teen has gastroesophageal reflux (GER), he or she may taste food or stomach acid in the back of the mouth.
- Before reaching this decision, the severity of the childâ€™s reflux will usually be assessed with an upper GI contrast study and a pH or impedance study.
In either case, the problem is usually manageable. In older children, the causes of GERD are often the same as those seen in adults. Also, an older child is at increased risk for GERD if he or she experienced it as a baby.
Complaints of abdominal pain (“stomachache”) were most common, reported by 23.9% and 14.7% of parents of 3- to 9-year-old and 10- to 17-year-old children and by 27.9% of children aged 10 to 17 years. In those aged 10 to 17 years, heartburn reported by the children was associated with reported cigarette use (odds ratio, 6.5; 95% confidence interval, 2-21); no other complaint was associated with cigarette, alcohol, or caffeine consumption or passive smoking exposure. In 3- to 9-year-old children, no complaint was associated with caffeine consumption or passive smoking exposure. Reported treatment in the past week with antacids was 0.5% according to parents of children aged 3 to 9 years and 1.9% and 2.3% according to parents of children aged 10 to 17 years and children aged 10 to 17 years, respectively.
What is the treatment for GER?
The study reported that obese children had seven times higher odds of reporting multiple GERD symptoms and that asthma symptoms were closely associated with gastroesophageal reflux symptom scores in obese patients but not in lean patients. Signs and symptoms in older children include all of the above plus heartburn and a history of vomiting, regurgitation, unhealthy teeth, and halitosis. pH monitoring. To measure the acidity inside of the esophagus.
The sphincter is not as effective in infants, so some formula or food can come back up, causing the baby to spit up. In view of the ongoing vomiting and slowed weight gain, Jamesâ€™ GP prescribed ranitidine for the presumptive diagnosis of gastro-oesophageal reflux disease (GORD). Despite good medication compliance, Jamesâ€™ weight continued to decrease to just above the third percentile, with length on the 10th percentile, by 6 months of age.
This aspect, in conjunction with abdominal wall muscle contraction (if it occurs during periods of LES relaxation) propels refluxate into the esophagus, with subsequent regurgitation. Reflux is facilitated when an increase in intraabdominal pressure occurs. In some cases, and particularly in children with neurodevelopmental disabilities, the presence of a chronically lax LES associated with decreased or even absent sphincter tone results in severe gastroesophageal reflux. Most cases of pediatric gastroesophageal reflux are diagnosed based on the clinical presentation. Conservative measures can be started empirically.