Gastroesophageal Reflux in Infants and Children

Am Fam Physician. 2015;92(8):1-2

See related article on gastroesophageal reflux in infants and children

What is reflux?

Reflux (also called gastroesophageal reflux) happens when swallowed food or liquid in the stomach passes back up into the throat and mouth through a tube called the esophagus (eh-SOF-ah-gus). “Spitting up” (also called regurgitation) is a form of reflux that happens in infants when the swallowed liquid or food moves from the stomach and into the mouth. Spitting up is considered normal in most infants. It is usually worst around four months of age, and gets better by one year of age. Sometimes, toddlers, children, and adolescents have reflux.

If reflux causes your infant or child to have pain, heartburn, weight loss, or other concerning symptoms, then he or she might have gastroesophageal reflux disease (GERD) and should see a doctor.

What causes it?

When we eat, food passes from the mouth down the esophagus. The food must pass through an opening between the esophagus and stomach. This opening acts like a gate to allow food to pass into the stomach. Usually, this opening closes as soon as food passes through. If it doesn't close all the way, food and liquid from the stomach can move back through the opening and into the esophagus. This is called reflux.

What makes it worse?

Many things can make reflux worse. It is most common in infants and children after large meals and when lying on their back after a meal. Some medical problems can make reflux worse, such as:

Hiatal hernias (when a part of the stomach moves up through the diaphragm muscle into the chest)
Nervous system disorders, such as cerebral palsy or mental retardation
Cystic fibrosis
Seizure disorders
Asthma
Obesity

What can I do to help my infant or child with reflux?

Most reflux does not need to be treated. It usually goes away by 12 months of age. There are some things you can try to help your child's reflux:

Change your infant's body positioning after feeding (discuss this with your doctor first)
Try smaller and more frequent feedings
Add a thickener, such as rice cereal, to infant formula or breast milk (1 tablespoon of cereal per ounce of formula or milk)
Use formulas specifically designed to reduce reflux
Breastfeeding moms can avoid drinking cow's milk and eating eggs
Avoid late evening meals in older children
Avoid carbonated beverages, like soda, in children
Encourage weight loss in children who are obese

What if symptoms get worse?

If these steps don't help your child's symptoms, talk with your doctor. He or she may recommend a test to see what is causing the reflux. Some types of tests include an acid test to check for acid in the esophagus, or an endoscopy (a video camera on a long, thin tube passed through the mouth, down the esophagus, and into the stomach). However, most of the time, tests are not needed.

Infants and children with reflux usually do not need medicine. But, if your child is not getting better, your doctor might prescribe a medicine that decreases the amount of acid in the stomach. These medicines include histamine H₂ receptor antagonists (H2RAs) and proton pump inhibitors (PPIs).

Can reflux be serious?

Yes. Painful or troublesome reflux that is not treated can lead to poor eating, weight loss, and other diseases of the esophagus or stomach.

There are some serious medical conditions that can cause reflux symptoms. If your infant or child is vomiting stomach bile or blood, or has blood in bowel movements, see your doctor immediately or go to the emergency department.