Acid reflux is a common condition in children that can cause discomfort and impact their quality of life. Gastroesophageal reflux disease (GERD), a more severe form of acid reflux, can lead to complications if left untreated.

Recognising the signs and symptoms of GERD in children is crucial for parents to provide timely intervention and management.

This comprehensive guide aims to explore the nuances of acid reflux in children, highlighting causes, symptoms, diagnosis, treatment options, and practical tips for parents to navigate the challenges of managing GERD in their little ones.

How to Test for GERD in a Child

If you suspect your child has GERD, it’s essential to consult a paediatrician. Diagnosing GERD involves a combination of medical history, physical examination, and specialised tests.

1. Medical History and Symptom Evaluation

The first step in diagnosing pediatric reflux involves a thorough consultation with the paediatrician. During this discussion, the paediatrician will inquire about various factors, including:

• The frequency, timing, and triggers of reflux episodes, such as vomiting, heartburn, or irritability.
• Any issues related to feeding, such as refusal to eat or regurgitation of food.
• Any history of GERD, food allergies, or digestive disorders within the family.
• Any concerns related to poor weight gain or growth delays, which may indicate complications related to GERD.

2. Physical Examination

The doctor will perform a thorough physical exam to rule out other potential causes of symptoms, such as infections, allergies, or anatomical issues.

3. Diagnostic Tests

If GERD is suspected but not definitively diagnosed through history and examination, the following tests may be recommended:

• pH Monitoring (Esophageal pH Probe Test): This procedure measures the acidity levels in the oesophagus over a 24-hour period. A small, flexible tube with a sensor is inserted through the nose and positioned in the oesophagus. The tube is then connected to a monitor that records acid levels. This test helps to identify the frequency and duration of acid reflux occurrences, especially during sleep or after meals.
• Endoscopy (Esophagogastroduodenoscopy or EGD): This procedure uses a camera-equipped tube to examine the oesophagus, stomach, and duodenum for signs of inflammation or damage caused by acid reflux. It involves taking tissue samples for biopsy to identify conditions like eosinophilic esophagitis or infections. It is done while the patient is sedated.
• Barium Swallow X-ray (Upper GI Series): This procedure identifies structural abnormalities, such as a hiatal hernia or oesophageal narrowing, in children. The child ingests a barium-containing liquid that coats the digestive tract, allowing X-rays to highlight any abnormalities present. While this procedure does not directly confirm GERD, it aids in identifying anatomical issues that may be contributing to reflux.
• Esophageal Manometry: Oesophageal manometry is a diagnostic procedure that evaluates the strength and coordination of the muscles in the oesophagus, specifically focusing on the lower oesophageal sphincter (LES). Oesophageal manometry is a test that measures the muscle function in the oesophagus by inserting a tube. It is helpful for children with swallowing issues or for cases considering surgery.
• Impedance-pH Monitoring: This advanced technology detects both acidic and non-acidic reflux episodes, offering a more thorough evaluation compared to standard pH monitoring. By combining pH monitoring with sensors that detect liquid movement in the oesophagus, this innovative system provides a comprehensive assessment of reflux. It is particularly beneficial in evaluating reflux in children with atypical symptoms, such as coughing or wheezing.

4. Trial of Acid-Suppressing Medications

Sometimes, doctors may recommend a trial of proton pump inhibitors (PPIs) or H2 blockers without invasive tests. If symptoms improve during the trial, it supports the GERD diagnosis.

Causes and Risk Factors of GERD in Children

GERD, or Gastroesophageal Reflux Disease, is a chronic digestive disorder that occurs when stomach acid flows back into the oesophagus. While it is more commonly associated with adults, GERD can also affect children. Several causes and risk factors contribute to the development of GERD in children, including a weak lower oesophageal sphincter (LES) muscle that allows stomach acid to leak into the oesophagus. Other factors such as certain medical conditions like obesity, asthma, or neurological disorders can also increase the risk of developing GERD in children.

Certain lifestyle habits, like eating fatty or spicy foods, overeating, or lying down after meals, can make GERD symptoms worse in children. It’s important to see a healthcare professional for a thorough evaluation to determine the cause and get the right treatment.

Treatment of Acid Reflux in Children

Treating acid reflux in children requires a multifaceted approach tailored to their age, symptom severity, and underlying causes. While occasional reflux can often be managed with simple lifestyle changes, more persistent cases, known as gastroesophageal reflux disease (GERD), may require medical or surgical intervention.

1. Lifestyle and Dietary Changes

For many children, making adjustments to daily habits can significantly alleviate symptoms of acid reflux.

• Infants: Feeding smaller amounts can help decrease the chances of spit-up and reflux, as well as aid in releasing gas and alleviating pressure on the stomach. It is recommended to hold the infant upright for a minimum of 30 minutes after feeding to reduce regurgitation. For bottle-fed babies, using a slow-flow nipple can prevent overfeeding and minimize air swallowing.
• Toddlers and Older Children: To prevent acid reflux in children, avoid trigger foods like spicy, fatty, and fried foods, chocolate, caffeine, carbonated beverages, and acidic fruits. It’s important to eat smaller portion sizes, avoid eating before bedtime, and maintain a healthy weight. Elevating the head of the bed can also help reduce symptoms, especially at night.

2. Medications

If lifestyle changes are insufficient, doctors may recommend medications to manage acid reflux in children. These medications aim to reduce stomach acid or protect the oesophagus.

• Antacids: Antacids such as calcium carbonate (Tums) work by neutralising stomach acid to provide fast relief. However, they are only recommended for occasional use as prolonged use can interfere with the absorption of calcium.
• H2 Blockers: Histamine receptor antagonists such as Ranitidine and Famotidine block acid production in the stomach, making them effective for mild to moderate GERD. However, long-term use should be supervised by a doctor.
• Proton Pump Inhibitors (PPIs): Medications such as Omeprazole and Lansoprazole work by blocking acid-secreting pumps in the stomach to reduce stomach acid production. They are helpful for healing esophagitis and severe GERD but may have side effects like diarrhoea or nutrient malabsorption if used for a long time.
• Prokinetics: Medications such as Metoclopramide and Domperidone help improve digestion by increasing muscle contractions in the digestive tract. However, they are prescribed with caution due to potential side effects like drowsiness and irritability.

3. Natural and Home Remedies

Parents can use gentle, natural remedies such as probiotics, aloe vera juice, and chamomile or ginger tea to complement medical treatment for children. These remedies can help with gut health, soothing the esophagus, and calming the stomach. However, it’s important to consult a doctor before giving these remedies to young children and to avoid over-the-counter remedies without medical advice.

4. Behavioral and Environmental Adjustments

Behavioural changes, like stress management and good eating habits, can help reduce reflux symptoms in older children. Techniques such as mindfulness and deep breathing, along with encouraging good eating habits like chewing food thoroughly, eating slowly, and drinking water instead of sugary drinks, can be effective in managing GERD.

5. Treatment for Nighttime Reflux

Nighttime acid reflux in children can disrupt sleep. To address symptoms, try elevating the sleeping position, modifying the bedtime routine to avoid lying down right after eating, sleeping on the left side to reduce acid exposure, and using nighttime medication prescribed by the paediatrician if needed.

Emotional and Social Impacts of GERD in Children

GERD can hurt children’s physical health, emotional well-being, and social interactions. Chronic symptoms can cause pain, disrupted sleep, anxiety, and self-consciousness, affecting their quality of life.

Let’s take a look at these impacts to help parents and caregivers provide holistic support to children with GERD.

Emotional Impacts

• Anxiety and Stress: Children with GERD may experience heightened anxiety and stress due to the unpredictability and discomfort of their symptoms. Chronic pain, especially during sleep, can lead to sleep disturbances, exacerbating feelings of irritability and tension.
• Low Self-Esteem: Frequent symptoms and the need for medical interventions can affect a child’s self-image. They may feel different from their peers, leading to decreased self-esteem and self-worth.
• Mood Disturbances: Persistent discomfort from GERD can make children more prone to mood swings and irritability. The constant battle with symptoms may lower their tolerance for frustration and reduce their overall emotional resilience.

Social Impacts

• Social Isolation: Children with GERD might avoid social activities that could exacerbate their symptoms, such as eating out, participating in sports, or attending sleepovers. This avoidance can lead to social isolation and loneliness.
• Stigma and Bullying: Children may face teasing or bullying if their symptoms are visible or if they need to take breaks during activities. The stigma associated with having a chronic illness can affect their willingness to participate in group settings.
• Academic Challenges: Frequent absences from school due to medical appointments or severe symptoms can hinder academic progress and affect relationships with teachers and classmates. Struggling academically may further impact a child’s social standing and self-esteem.

Sources:

• https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-children/symptoms-causes
• https://www.hopkinsmedicine.org/health/conditions-and-diseases/gerd-gastroesophageal-reflux-disease-in-children
• https://kidshealth.org/en/parents/gerd-reflux
• https://medlineplus.gov/refluxinchildren
• https://choc.org/programs-services/gastroenterology/gerd/
• https://www.momjunction.com/articles/acid-reflux-in-children
• https://www.webmd.com/parenting/baby/infants-children
• https://www.uhhospitals.org/health-information/health-and-wellness-library/article/diseases-and-conditions—pediatrics/gerd-gastroesophageal-reflux-disease-in-children