Reflux
Gastroesophageal reflux happens when stomach contents come back up into the esophagus (the tube that connects the mouth and stomach). Reflux is very common in babies, who often spit up after they are fed. Babies usually outgrow reflux, and it’s less common among older children.
Reflux occurs when the sphincter (circular muscle) at the lower end of the esophagus relaxes. This muscle normally opens during swallowing to let food into the stomach and then closes to keep it there. With reflux, the muscle relaxes at the wrong time, allowing stomach contents to travel back up the esophagus.
In babies, this muscle usually gets stronger and remains closed better as they grow, and their reflux improves. For some children, however, the reflux gets worse and can become gastroesophageal reflux disease (GERD). If GERD isn’t treated, it can eventually lead to more serious health
Symptoms
Stomach contents are acidic, and when they come back up, they can cause a burning sensation in the throat or mouth known as heartburn. While most babies and young children with reflux remain happy and healthy, it sometimes can cause the following:
Frequent spitting up or vomiting
Fussiness and crying after eating
Eating only small amounts or refusing to eat
If your baby or toddler has blood in their vomit, wheezing or frequent choking, they should see a doctor. You should also take your child to the doctor if they are losing weight or don’t seem to be growing on schedule. These could be signs that your child has GERD.
Older children who have reflux may complain of heartburn, and they also may taste food or stomach acid in the back of their mouth. If this happens more than twice a week, it may be GERD. Other symptoms of GERD in children include:
Bad breath
Nausea and vomiting with blood or greenish-yellow fluid
Hoarseness
Difficulty swallowing
A feeling of food stuck in the throat
Trouble breathing, such as wheezing or a chronic cough
Diagnosis
Reflux in babies usually goes away on its own by about one year of age. However, babies and children with symptoms of GERD should see a doctor.
Your specialist at Orlando Health Children's Arnold Palmer Hospital Center for Digestive Health and Nutrition will ask about your child’s symptoms and any other conditions they may have. For example, children with asthma often have reflux or GERD as well. Your specialists will also do a physical exam.
The physical exam and symptoms may be enough to diagnose reflux. If your specialist suspects your child may have GERD, they may suggest one or more of the following tests:
Blood or urine tests. These can help rule out a more serious condition.
PH monitoring. This checks the level of stomach acid in the child’s esophagus.
Upper endoscopy. During this test, your child is sedated and the doctor passes a thin, flexible tube with a camera through your child’s mouth and into the stomach. This test can show inflammation, infection, ulcers and other problems.
Barium study. During this test, your child swallows a chalky liquid called barium, which is then tracked through the upper part of their digestive system with X-rays. This ensures the anatomy or position of the upper part of the GI tract is normal. It can also look for a hiatal hernia.
Treatments
Reflux can often be treated at home. For babies, it can help to feed smaller amounts more often — your doctor can tell you what amount and timing is best. For formula-fed babies, doctors sometimes recommend adding one tablespoon of rice cereal per ounce of formula to thicken it.
Babies with reflux usually do better on a regular feeding schedule. If your baby spits up, don’t feed them again right away. It’s best to wait until the next feeding time. Burp your baby frequently and avoid tight diapers and waistbands.
Smaller and more frequent meals also are helpful for toddlers and older children with reflux. These strategies also can help:
Avoid feeding your child within two to three hours of bedtime.
Help overweight kids lose weight.
Keep your child away from tobacco smoke, which can make reflux worse.
Elevate the head of your child’s bed 30 degrees.
Don’t give your child carbonated drinks, chocolate, caffeine or foods that are high in fat. Also avoid spicy foods and those with a lot of acid, such as citrus fruits, tomatoes and pickles.
Your doctor also may recommend an over-the-counter antacid or a prescription medication to stop acid production or help the stomach empty. A combination of medicines may work better than a single drug.
Next Steps
When a child has problems with reflux, it can be stressful for the whole family. At Orlando Health Children's Arnold Palmer Hospital Center for Digestive Health and Nutrition, our doctors, nurses and others provide the care your child needs to recover from reflux or GERD, and we take steps to ensure your family is coping well.
Caring for your child and your family takes a team of experts who are committed to your success. That’s what we do, every day.
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