Pediatric GERD: Causes, Symptoms, Diagnosis, and Treatment in Children

Gastroesophageal reflux disease (GERD) in children, commonly known as pediatric GERD, is a chronic digestive condition where stomach acid frequently flows back into the esophagus, irritating its lining. While occasional reflux is common and usually harmless, GERD is more severe and persistent, requiring medical attention to prevent complications.

GERD can develop in infants, children, and adolescents for several reasons, including:

• Immature Digestive System: In infants, an underdeveloped lower esophageal sphincter (LES) can lead to reflux, though most infants outgrow it by their first year.

• Dietary Triggers: Certain foods, such as chocolate, citrus, and spicy or fatty foods, may trigger reflux in children.

• Obesity: Excess weight can put pressure on the stomach, leading to acid reflux.

• Hiatal Hernia: A condition where part of the stomach pushes up into the chest, allowing acid to escape into the esophagus.

• Neurological Disorders: Conditions affecting muscle control, like cerebral palsy, may increase GERD risk.

The symptoms of GERD in children vary depending on age:

• Infants: Frequent spitting up or vomiting, irritability during feeding, arching of the back, refusal to eat, coughing, and slow weight gain.

• Children and Adolescents: Heartburn, stomach pain, chest pain, difficulty swallowing, sour taste in the mouth, regurgitation, hoarseness, and chronic cough.

Diagnosing GERD involves evaluating symptoms, performing physical examinations, and possibly conducting specific tests, including:

• Esophageal pH Monitoring: Measures acid levels in the esophagus over a 24-hour period to confirm GERD.

• Endoscopy: A flexible tube with a camera is inserted into the esophagus to examine inflammation or damage.

• Upper GI Series: X-rays taken after a barium swallow can reveal structural abnormalities in the digestive tract.

• Esophageal Manometry: Measures the function of the LES and esophageal muscles to assess swallowing function.

Treatment varies based on the child’s age, severity of symptoms, and response to initial therapies. Options include:

• Lifestyle and Dietary Changes: Small, frequent meals, avoiding trigger foods (e.g., acidic, spicy foods), keeping the child upright after eating, and elevating the head of the bed can help reduce symptoms.

• Medications:

- Antacids (for short-term relief): Neutralize stomach acid and provide quick relief from heartburn.

- H2 Blockers (e.g., ranitidine, famotidine): Reduce acid production in the stomach.

- Proton Pump Inhibitors (PPIs) (e.g., omeprazole, lansoprazole): Reduce acid production more effectively and are typically prescribed for moderate to severe GERD.

• Surgery: In severe cases, such as when medications and lifestyle changes don’t work, a surgical procedure called fundoplication may be considered. This involves tightening the LES to prevent reflux.

While GERD cannot always be prevented, certain lifestyle practices can help manage symptoms:

• Avoid overfeeding infants; opt for smaller, frequent feedings.

• Keep older children away from trigger foods (e.g., caffeine, chocolate, carbonated drinks).

• Encourage weight management and healthy eating.

• Avoid lying down immediately after meals.

If untreated, GERD in children can lead to complications, including:

• Esophagitis: Inflammation of the esophagus, causing pain and potential bleeding.

• Esophageal Stricture: Narrowing of the esophagus due to scarring, leading to swallowing difficulties.

• Respiratory Issues: GERD can cause or exacerbate conditions like asthma, pneumonia, or bronchitis due to acid entering the lungs.

• Barrett’s Esophagus: A precancerous condition that increases the risk of esophageal cancer in the future.

Seek medical attention if your child exhibits severe or persistent symptoms, such as:

• Difficulty swallowing or painful swallowing

• Chronic cough or hoarseness

• Vomiting with blood

• Poor weight gain or significant weight loss

• Chronic stomach pain, especially after eating

• Pediatric GERD is a chronic digestive condition where stomach acid flows back into the esophagus, causing symptoms like heartburn, chest pain, and vomiting.

• Diagnosis includes pH monitoring, endoscopy, and imaging studies.

• Treatment involves lifestyle changes, medications, and in severe cases, surgery.

• Early intervention can prevent complications, improving the quality of life for affected children.