Hiatal Hernia
Overview
A hiatal hernia occurs when the top part of the stomach pushes through the diaphragm (the muscle separating the abdomen and the chest). Everyone has a small opening in this area, known as a hiatus. An unusually large hiatus can lead to a hiatal hernia. This condition can occur in a child of any age.
There are three main types of hiatal hernias:
Sliding hiatal hernia. The most common type causes part of the stomach to move from the abdomen up into the chest.
Paraesophageal hiatal hernia. This rare type occurs when the stomach bulges through an opening in the diaphragm alongside the esophagus (tube that carries food from the mouth to the stomach).
Mixed hiatal hernia. This type combines the above two types.
Symptoms of Hiatal Hernia
Small hiatal hernias may not cause any symptoms and can remain undetected. Larger hiatal hernias can cause troublesome symptoms and usually requires treatment. Signs and symptoms of larger hiatal hernias may include:
Acid reflux (stomach acid flowing into the throat) or heartburn
Trouble swallowing
Vomiting liquids or food into the mouth
Black stool
Pain in the chest or abdomen
Shortness of breath
Vomiting blood
When to see a doctor
Take your child to see a pediatrician (doctor who specializes in treating children) right away if they experience any of the above symptoms.
Causes of Hiatal Hernia
Causes of this condition can include:
Having an unusually large hiatus (diaphragm opening)
Injury to the upper abdomen
Repeated strain on the diaphragm, such as from coughing, vomiting, straining during a bowel movement, lifting heavy objects or heavy exercise
Who’s at risk
Being born with a large hiatus or having suffered an injury to the upper abdomen can put a child at an increased risk of developing a hiatal hernia.
Diagnosis of Hiatal Hernia
Your child’s pediatrician (doctor who specializes in treating children) will likely refer your child to a specialist (either a gastroenterologist or a pediatric surgeon). These providers will order one or more of the following tests to confirm a hiatal hernia in your child:
Imaging. An X-ray imaging test creates detailed pictures of the inside of your child’s body. Your child may also need to undergo an upper GI series, which is a series of X-rays as your child swallows contrast dye.
Upper endoscopy. This test uses a tiny camera attached to a thin tube to closely examine the upper portion of your child’s digestive tract. The gastroenterologist threads the camera down your child’s throat. Your child will receive medicine to help relax and decrease pain during this test.
Esophageal manometry. This test measures the muscle contractions of your child’s throat while they swallow.
Treatments for Hiatal Hernia
If your child’s hiatal hernia is mild and not causing symptoms, they may not need treatment.
If your child’s hiatal hernia is causing symptoms, they will likely need surgery. This surgery is often done at the same time as an “anti-reflux” procedure called a Nissen fundoplication. Typically, these surgeries are performed using minimally invasive, laparoscopic (inserting a small camera in the body) techniques. Your child will be under general anesthesia (fully asleep) for the procedure.
During the surgery and depending upon your child’s unique situation, the surgeon may:
Make the hiatus (diaphragm opening) smaller by stitching it closed
Pull the stomach down into the abdomen
Remove the sac-like area pressing through the diaphragm (hernia sac)
After surgery, your child will spend several hours in a recovery area. Their care team will closely monitor them as they wake up from the anesthesia. Your child will likely spend a few days in the hospital for recovery.
Home remedies
The following lifestyle changes may help control your child’s symptoms prior to undergoing surgery, or if the symptoms are mild and don’t require surgery:
Avoiding foods that can cause heartburn, including:
Caffeine
Chocolate
Fried food
Garlic
Mint
Onion
Tomato sauce
Eating smaller amounts of food throughout the day, instead of three larger meals
Elevating the head off the bed at least six inches
Not eating three hours before going to bed
Not laying down immediately after eating
Taking over-the-counter heartburn medications
Contact Us
If you suspect that your child may have Hiatal Hernia, make an appointment with an Orlando Health pediatrician today so your child can start on the road to improved health.
