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Gastroesophageal Reflux Disease—Infant

(GERD—Infant; Chronic Heartburn—Infant; Reflux Esophagitis—Infant; Gastro-oesophageal Reflux Disease—Infant; GORD—Infant; Heartburn—Infant; Reflux—Infant)

Definition

Gastroesophageal reflux (GER) is a back up of acid or food from the stomach to the esophagus. The esophagus is the tube that connects your mouth and stomach. GER is common in babies. It causes them to spit up. Most babies outgrow GER within 12 months.
After 18-24 months, esophageal injury and additional symptoms may point to gastroesophageal reflux disease (GERD). GERD is pain and swelling in the esophagus. It is caused by the regular flow of acid to the esophagus. GERD can cause serious health issues. The sooner it is treated, the better the outcome.
Gastroesophageal Reflux Disease
EC00059 97870 1 gerd stomach
Food and acid back up into the esophagus from the stomach.
Copyright © Nucleus Medical Media, Inc.

Causes

GERD is caused by acid or food that regularly backs up into the esophagus. It is not always clear why the acid backs up. The reasons may also vary from person to person. There may be a genetic link in some GERD.
Acid is kept in the stomach by a valve at the top of the stomach. The valve opens when food comes in. It should close to keep in the food and acid. When this valve does not close properly, the acid can flow out of the stomach. In addition to GERD, the valve may not close because of:
  • Problems with the nerves that make the valve open or close
  • Increased pressure in the stomach such as too much food in the stomach or pressure on the abdomen
  • Irritation in the stomach or muscles of the valve
  • Problem with the valve itself

Risk Factors

Factors that may increase your baby's risk of GERD include:

Symptoms

GER is very common in the first year of life. If GER symptoms worsen or don’t improve by 18 months, ask the doctor to re-evaluate your baby.
Symptoms may include:
  • Spitting up or vomiting
  • Not growing or gaining weight
  • Refusal to feed or difficulty feeding
  • Irritability or fussiness during or after feeding
  • Arching of back or other movements during or after feeding
  • Regurgitation or bloody vomit
  • Breathing problems
  • Difficulty swallowing
  • Frequent pneumonia or respiratory problems
  • Apnea or blue skin when not enough blood gets to the lungs
  • Cough or wheezing
  • Hoarseness
  • Disturbed sleep
  • Excessive crying

Diagnosis

Your doctor will ask about your baby’s symptoms and medical history. A physical exam will be done. Your baby may need to see a pediatric gastroenterologist. This is a doctor who focuses on problems of the stomach and intestines.
Images may need to be taken of your baby's stomach and esophagus. This can be done with an upper GI series .
Your baby's bodily fluids and tissues may need to be tested. This can be done with an upper endoscopy with biopsy.
Other tests may include:
  • 24-hour pH monitoring—a probe is placed in the esophagus to keep track of the acid in the lower esophagus
  • Short trial of medicine—success or failure of medication may help your doctor understand the cause

Treatment

Talk with your doctor about the best treatment plan for your baby. Treatment options include the following:

Lifestyle Changes

Lifestyle change can help improve symptoms. Your doctor may suggest these lifestyle changes:
Lifestyle change can help improve symptoms. Your doctor may suggest these lifestyle changes:
  • Try a hypoallergenic formula for one to two weeks. This formula has removed items linked with common allergic reactions.
  • Provide small, frequent feedings
  • Thicken your baby’s formula or milk. Use rice, cereal or another thickening agent.
  • Use a different pre-thickened formula.
  • Burp your baby more often. For example, burp your baby every one to two hours after being fed.
  • Make sure your baby is in an upright position during feeding. Keep your baby upright for 30 minutes after being fed.
  • Keep a diary of your baby's symptoms.
  • Ask your doctor about sleeping positions. These positions depend on your baby's age. Young babies should always be placed on their back because of the risk of sudden infant death syndrome .
  • Keep your baby away from second-hand smoke.

Medications

In most cases, treatment starts with making lifestyle changes. Medication may be given if your baby's GERD doesn't improve. The medication can help to decrease acid in the stomach and help the area heal. Medication options may include:
  • Histamine-2 receptor drugs—to decrease acid production and promote healing
  • Proton pump inhibitors—also decreases acid production and promote healing

Surgery

Surgery or endoscopy may be recommended with more severe cases.
The most common surgery is called fundoplication . During this procedure, a part of the stomach will be wrapped around the stomach valve. This makes the valve stronger. It should prevent stomach acid from backing up into the esophagus. This surgery is often done through small incisions in the skin.

Prevention

The cause of GERD is largely unknown. You can take steps to control it in your baby by:
  • Following lifestyle and dietary changes
  • Keeping your baby away from second-hand smoke
  • Keeping a diary of your baby's symptoms

RESOURCES

GIKids.org—North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) http://www.gikids.org

National Digestive Diseases Information Clearinghouse (NDDIC) http://digestive.niddk.nih.gov

CANADIAN RESOURCES

About Kids Health http://www.aboutkidshealth.ca

Canadian Digestive Health Foundation http://www.cdhf.ca

References

Gastroesophageal reflux disease in infants. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated June 22, 2012. Accessed May 10, 2013.

Gastroesophageal reflux in infants. National Digestive Diseases Information Clearinghouse website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/gerdinfant/index.htm. Updated February 21, 2012. Accessed May 10, 2013.

Pediatric GE reflux clinical practice guidelines. J Pediatr Gastroenterol Nutr. 2001;32:S1-S31.

1/6/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Orenstein SR, McGowan JD. Efficacy of conservative therapy as taught in the primary care setting for symptoms suggesting infant gastroesophageal reflux. J Pediatr. 2008;152:310-314. Epub 2007 Nov 7.

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