About gastroesophageal reflux (ger and gerd) in infants and children
What is gastroesophageal reflux (ger and gerd) in infants and children?
Gastroesophogeal reflux (GER) is the upward flow of stomach contents from the stomach into the esophagus ("swallowing tube"). While not required by its definition, these contents may continue from the esophagus into the pharynx (throat) and may be expelled from the mouth. GER differs from vomiting in that it is generally not associated with a violent ejection. Moreover, GER is generally a singular event in time whereas the vomiting process is commonly several back-to-back events that may ultimately completely empty all stomach contents and yet still persist ("dry heaves"). The difference between GER and GERD (gastroesophogeal reflux disease) is a matter of severity and associated consequences to the patient.
The large majority of healthy, full term infants will have episodes of "spitting up" or "wet burps," which technically qualify to be considered GER. These infants generally do not seem in distress before, during, or after by the reflux process. Likewise, the loss of calories as an outcome of GER is inconsequential since growth parameters including weight gain are not affected. Lastly, there seem to be no short or long term consequences of these reflux experiences. In short, infants with GER are "messy spitters."
The very name of GERD ("disease") implies a much different condition. Infants and children with GERD often experience distress as a consequence of their reflux even if the refluxed stomach contents are not completely ejected from the mouth. Infants and young children may loose so many calories by expulsion that growth is compromised. Some infants or children with GERD may even become averse to feeding due to repeated associations with feeding and pain. Finally, there are a number of short and long term consequences of GERD that are not associated with infants and children with GER. These will be discussed further in this article.
What are the symptoms for gastroesophageal reflux (ger and gerd) in infants and children?
Reflux symptom was found in the gastroesophageal reflux (ger and gerd) in infants and children condition
See your baby's doctor if your baby:
- Isn't gaining weight
- Consistently spits up forcefully, causing stomach contents to shoot out of his or her mouth (projectile vomiting)
- Spits up green or yellow fluid
- Spits up blood or a material that looks like coffee grounds
- Refuses food
- Has blood in his or her stool
- Has Difficulty breathing or a chronic cough
- Begins spitting up at age 6 months or older
- Is unusually irritable after eating
Some of these signs can indicate possibly serious but treatable conditions, such as GERD or a blockage in the digestive tract.
What are the causes for gastroesophageal reflux (ger and gerd) in infants and children?
In infants, the ring of muscle between the esophagus and the stomach — the lower esophageal sphincter (LES) — is not yet fully mature. That allows stomach contents to flow back up. Eventually, the LES will open only when your baby swallows and will remain tightly closed at other times, keeping stomach contents where they belong.
The factors that contribute to infant reflux are common in babies and often can't be avoided. These factors include:
- Lying flat most of the time
- Consuming an almost completely liquid diet
- Being born prematurely
Occasionally, infant reflux can be caused by more-serious conditions, such as:
- GERD. The reflux has enough acid to irritate and damage the lining of the esophagus.
- Pyloric stenosis. A valve between the stomach and the small intestine is narrowed, preventing stomach contents from emptying into the small intestine.
- Food intolerance. A protein in cow's milk is the most common trigger.
- Eosinophilic esophagitis. A certain type of white blood cell (eosinophil) builds up and injures the lining of the esophagus.
- Sandifer syndrome. This causes abnormal tilting and rotation of the head and movements that resemble seizures. It's a rarely seen consequence of GERD.
What are the treatments for gastroesophageal reflux (ger and gerd) in infants and children?
Rarely, an infant with GER generates substantial discomfort, demonstrate an aversion to feeding, or show suboptimal weight gain. Conversely, toddlers and older children may experience more substantial symptoms, and thus may need a trial of lifestyle modifications including:
- mild elevation of the head of the bed,
- serving smaller but more frequent meals,
- monitoring your child's diet to determine whether specific foods or drinks may tend to aggravate his or her symptoms, and
- weight reduction if indicated.
There are several groups of medications that may need to be considered in certain cases of infant GER (rare) or toddler/childhood GERD. These include:
- Medication to lessen gas, for example, Mylicon or Gaviscon
- Medication to neutralize stomach acid, for example, Mylanta or Maalox
- Medication to lessen stomach acid histamine blockers, for example, famotidine (Pepcid) or cimetidine (Tagamet), and proton pump inhibitors or PPIs, for example, omeprazole (Prilosec), lansoprazole (Prevacid), or rabeprazole (Aciphex)
- Medication to promote emptying of stomach contents, for example, metoclopramide (Reglan, however, it has several side effects) or erythromycin (more routinely used as an antibiotic but known to have side the effect of increasing stomach contractions, but may be helpful with GERD)
The use of these medications follows a stepwise approach (from #1 to #4) based upon the severity of symptoms. Consultation with a pediatric gastroenterologist may be helpful for patients whose response to the above approach is disappointing.
There are very cases where children whose GERD is so severe that a surgical procedure must be considered to manage symptoms. The procedure, called a Nissen fundoplication, involves wrapping the top part of the stomach around the lower esophagus. The displaced stomach contracts during the digestive process, and thus closes off the lower esophagus and prevents reflux. In extraordinary circumstances, a feeding tube directly into the stomach is necessary to complement the Nissen fundoplication.
What natural or home remedies treat GER in infants?
Since the fundamental issue for infants with GER is "tincture of time," most infants need no specific therapy. Lifestyle adjustments that have been helpful for some infants include:
- Mild elevation of the head of the crib mattress
- Maintaining an upright position for the first 20 to 30 minutes following a feeding
- Thickening of the formula with rice cereal
- Utilization of an "elemental" formula (for example, Alimentum)
- Introduction of solid foods at the safe and appropriate age (please check with your child's pediatrician prior to initiating these processes).
Rarely, an infant may require medications to bridge the gap during the neurologic maturation process that enables your child to "outgrow" his or her GER. These medications are discussed later.
What are the risk factors for gastroesophageal reflux (ger and gerd) in infants and children?
Cleft Palate and Hearing Problems
Is there a cure/medications for gastroesophageal reflux (ger and gerd) in infants and children?
There are two types of hyperaldosteronism, known as primary and secondary hyperaldosteronism. While they have similar symptoms, their causes are different.
Primary hyperaldosteronism
Primary hyperaldosteronism is caused by a problem with one or both adrenal glands. It’s sometimes referred to as Conn’s syndrome.
Some people are born with overactive adrenal glands. Others might have it due to:
- a benign tumor on one of the adrenal glands
- adrenocortical cancer, which is a rare aldosterone-producing cancerous tumor
- glucocorticoid-remediable aldosteronism, a type of aldosteronism that runs in families
- other types of inheritable issues that affect the adrenal glands
Secondary hyperaldosteronism
Secondary hyperaldosteronism is caused by something outside the adrenal glands. It’s usually related to reduced blood flow to your kidneys.
Several things can cause this, including:
- a blockage or narrowing of the renal artery
- chronic liver disease
- heart failure
- diuretic medications