Heartburn: Not Just for Adults—Kids Get It Too
Your family has just finished dinner when someone at the table starts feeling a burning sensation in their chest. It isn’t your spouse or Aunt Mabel, but your child. The burning sensation, or heartburn, is one symptom of gastroesophageal reflux disease (GERD). According to an article published in the American Journal of Medicine , GERD symptoms occur in about 2% to 22% of children between the ages of 3-18.
GERD happens when acid and food flow back up from the stomach and into the esophagus (the tube that connects the mouth to the stomach), potentially damaging the esophagus and causing chronic respiratory and other health problems.
According to a study in The American Journal of Gastroenterology , ]]>children with GERD]]> are also at risk for having ]]>GERD as an adult]]> . Fortunately, researchers say that detecting and treating GERD during childhood may result in better outcomes later in life.
What Causes Pediatric GERD?
GERD is caused by the weakening of a muscle called the lower esophageal sphincter (LES). When you swallow, it contracts to prevent stomach contents from flowing back up, or regurgitating, into the esophagus. Certain foods, medications, and conditions can relax the LES, allowing acid to regurgitate.
The American College of Gastroenterology recommends that your child avoid the following foods and beverages if he has GERD:
- Spicy, acidic, or tomato-based foods
- Fatty foods
- Citrus products (eg, orange juice)
- Apple juice (apples are fine)
- Chocolate and licorice
- ]]>Caffeinated]]> drinks (eg, soda, coffee, tea, hot chocolate)
All teenagers should also avoid ]]>smoking cigarettes]]> and drinking alcohol. However, those with GERD have an added incentive, since these activities can worsen their symptoms.
Gastroparesis, also known as delayed gastric emptying, may also contribute to GERD in children. When the stomach empties too slowly, it may cause bloating, increased acid secretion, and esophagitis (inflammation of the esophagus).
Got Milk? Got GERD?
Researchers have also considered whether milk might contribute to GERD. A study published in the Journal of Pediatric Gastroenterology and Nutrition found an association between GERD and cow ]]>milk allergy]]> in children. The study found that among 18 children with severe GERD, 10 were also allergic to cow’s milk. These same 10 had a significantly higher reflux index (a measurement of reflux severity) compared to those not allergic to cow’s milk.
What Are the Symptoms?
Symptoms of GERD in children include:
- Severe abdominal discomfort
- Lower chest pain
- Sensation of food or liquid regurgitating into the throat or mouth
- Sensation of food stuck down in the throat
- Difficulty or pain while swallowing
- Poor weight gain or weight loss
- ]]>Anemia (low iron count)]]>
- Respiratory problems such as wheezing, cough, ]]>pneumonia]]> , and ]]>asthma]]>
To help your child communicate how he is feeling and to better understand the symptoms, the Children’s Digestive Health and Nutrition Foundation suggest asking your child the following questions:
- Where does your tummy hurt? (Ask your child to point to where it hurts.)
- Does it hurt in your chest?
- Does it hurt when you eat or drink?
- Do you get a yucky or sour taste in your mouth? Does it taste like throw-up?
- Does food sometimes get stuck in your throat?
What Are the Treatment Options?
GERD can usually be diagnosed based on your child’s symptoms and a physical exam. Additional diagnostic tests are often not required. Once the diagnosis is made, it can be treated through lifestyle changes, medication, and surgery.
Changing your child’s diet may relieve mild symptoms. Avoiding GERD “trigger” foods (listed previously) may be the first step. The doctor may also suggest feeding your child smaller meals and avoiding food 2-3 hours before bedtime. Finally, elevating your child’s head at a 30° angle and having him sleep on the left side may also ease symptoms.
There are three classes of prescription medications to treat GERD: H2-blockers, proton pump inhibitors (PPIs), and prokinetic agents. H2-blockers and PPIs decrease the amount of acid in the stomach, while prokinetic agents strengthen the LES. Although there are some over-the-counter antacid medications that treat adult GERD, doctors do not recommend them for children.
H2-Blockers vs. PPIs
Although both classes of medications are effective, PPIs have been shown to relieve GERD symptoms in children who do not respond well to H2-blockers.
Keep in mind, however, that doctors stress that PPIs are only for short-term use. Side effects of both H2-blockers and PPIs include ]]>diarrhea]]> , dizziness, headaches, nausea, and vomiting. If your child has severe GERD, you should consult with a pediatric gastroenterologist to discuss a long-term treatment plan.
Prokinetic Agents—Use Caution When Given to Children
The prokinetic agents that have most commonly been used to treat GERD are ]]>metoclopramide]]> (Reglan) and ]]>cisapride]]> (Propulsid). Common side effects of Reglan include drowsiness and restlessness. Muscle spasms and jerky movements have also been seen in infants, as well as irritability. Taking metoclopramide for longer than three months may also increase the risk of developing tardive dyskinesia, a serious neurological condition. More importantly, Propulsid has been associated with abnormal heart rhythms in children. In 2000, the drug’s manufacturer, Janssen Pharmaceutica, stopped marketing Propulsid in the US. It is now only available to select patients who have not been helped by other therapies.
Surgery, such as a procedure called ]]>fundoplication]]> , is rarely used to treat children with GERD. Rather, it is reserved for severe cases or when medications and lifestyle changes do not relieve symptoms. Surgery can carry a significant risk of complications and may even fail. Some studies report that more than half of patients that undergo surgery are back on medications because their symptoms return. In addition, some patients develop new symptoms that were not present before surgery.
Take Action Now
GERD can be an uncomfortable condition for both you and your child. But there is help available. Recognizing and relieving your child’s symptoms now may benefit his health down the line.
Children’s Digestive Health and Nutrition Foundation
International Foundation for Functional Gastrointestinal Disorders
The Canadian Association of Gastroenterology
Dietitians of Canada
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Questions to ask your child about how they feel. Children’s Digestive Health and Nutrition Foundation website. Available at: http://www.cdhnf.org/questions_child.html . Accessed October 19, 2005.
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Last reviewed May 2009 by ]]>Kari Kassir, 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.
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