Gastroesophageal Reflux Disease—Infant
(GERD—Infant; Chronic Heartburn—Infant; Reflux Esophagitis—Infant; Gastro-oesophageal Reflux Disease—Infant; GORD—Infant; Heartburn—Infant; Reflux—Infant)
Pronounced: Gas-tro-ee-sof-a-geal re-flux disease
Gastroesophageal reflux disease (GERD) is a disorder that results from food and stomach acid backing up into the esophagus from the stomach.
GERD is different from gastroesophageal reflux (GER). GER is a common disorder seen in infants, which causes them to spit up. Most infants outgrow this within 12 months. If symptoms do not improve by 18 to 24 months, your infant may have GERD.
GERD can cause serious health issues. The sooner it is treated, the better the outcome.
Gastroesophageal Reflux Disease
The cause of GERD in infants is unknown. Several factors contribute to GERD including:
- Abnormal pressure to the lower esophageal sphincter (LES), a valve that keeps food in the stomach
- Narrow or short esophagus
- Possibly a genetic link
- Delayed emptying of the stomach (although studies have shown that this may not cause GERD in infants)
The following factors increase your infant's chance of developing GERD. If your infant has any of these risk factors, tell the doctor:
If your baby experiences any of these symptoms, do not assume it is due to GERD. Remember 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 infant.
These symptoms may be caused by other conditions. If your infant has any of these, tell the doctor:
- Failure to thrive
- Refusal to feed or difficulty feeding
- Irritability or fussiness after feeding
- Arching of back during or after feeding
- Regurgitation or bloody vomit
- Breathing problems
- Difficulty swallowing
- Recurrent pneumonia]]> or respiratory problems
- ]]>Apnea]]> or blue spells (called cyanosis), when not enough blood gets to the lungs
- Cough or wheezing
- Disturbed sleep
- Excessive crying
Your doctor will ask about your baby’s symptoms and medical history, and perform a physical exam. Your baby may need to see a pediatric gastroenterologist, a doctor who specializes in gastrointestinal diseases.
Tests may include:
- Upper GI series]]> —a series of x-rays of the upper digestive system taken after drinking a barium solution
- ]]>Upper endoscopy]]> with biopsy—a tube is inserted into esophagus to look at the lining and a piece of tissue is taken for testing
- 24-hour pH monitoring—a probe is placed in the esophagus to keep track of the level of acidity in the lower esophagus
- Short trial of medicine
Talk with your doctor about the best treatment plan for your child. Treatment options include the following:
Your doctor may suggest these lifestyle changes:
- Try a hypoallergenic formula for one to two weeks.
- Provide small, frequent feedings
- Thicken your baby’s formula or milk with rice or cereal.
- Use a different pre-thickened formula.
- Burp your infant more frequently (eg, every one to two hours after being fed).
- Make sure your infant is in an upright position for 30 minutes after being fed.
- Keep a diary of your infant's symptoms.
- Try certain positions when sleeping. These positions depend on your infant's age because of the risk of sudden infant death syndrome]]> .
Making changes to your baby's diet and sleep positions, as well as not exposing him to second-hand smoke, can improve symptoms. ]]>*¹]]>
In most cases, treatment starts with making lifestyle changes. If your infant's GERD doesn't improve, the doctor may recommend medication, such as:
- Histamine-2 receptor drugs—to decrease acid production (eg, Pepcid, Axid, Zantac)
- Proton pump inhibitors—to heal the esophagus lining and relieve symptoms (eg, Prilosec, Prevacid, Protonix, Nexium)
In severe cases, the doctor may recommend surgery. The most common treatment is called ]]>fundoplication]]> . During this procedure, the surgeon wraps part of the stomach around the lower esophageal sphincter. This makes the sphincter stronger and prevents stomach acid from backing up into the esophagus.
Children’s Digestive Health and Nutrition Foundation
National Digestive Diseases Information Clearinghouse (NDDIC)
About Kids Health
Canadian Digestive Health Foundation
Gastroesophageal reflux disease (GERD) in infants. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Accessed May 19, 2008.
Gastroesophageal reflux in infants. National Digestive Diseases Information Clearinghouse website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/gerdinfant/index.htm . Accessed May 19, 2008.
GERD in children with an underlying structural anomaly. Children’s Digestive Health and Nutrition Foundation website. Available at: http://gerd.cdhnf.org/User/Docs/PDF/CUSA_Brochure.pdf . Accessed May 19, 2008.
Pediatric gastroesophageal reflux, clinical practice guideline summary. Children’s Digestive Health and Nutrition Foundation website. Available at: http://gerd.cdhnf.org/User/Docs/PDF/GERD_8_pg_brochure_031604.pdf . Accessed May 19, 2008.
Pediatric GE reflux clinical practice guidelines. J Pediatr Gastroenterol Nutr. 2001;32:S1-S31.
*¹1/6/2009 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : 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.
Last reviewed November 2008 by ]]>Daus Mahnke, MD]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
Copyright © 2007 EBSCO Publishing All rights reserved.