What Causes Reflux in Babies and Children?

Most of the time, reflux in babies is due to a poorly coordinated gastrointestinal tract. Many infants with the condition are otherwise healthy; however, some infants can have problems affecting their nerves, brain, or muscles. According to the National Digestive Diseases Information Clearinghouse, a child's immature digestive system is usually to blame and most infants grow out of GERD by the their first birthday. In older children, the causes of GERD are often the same as those seen in adults. Anything that causes the muscular valve between the stomach and esophagus (the lower esophageal sphincter, or LES) to relax, or anything that increases the pressure below the LES, can cause GERD. Certain factors also may contribute to GERD, including obesity, overeating, eating spicy or fried foods, drinking caffeine, and specific medications. There also appears to be an inherited component to GERD, as it is more common in some families than in others. What Are the Symptoms of Reflux in Infants and Children? The most common symptoms of gastroesophageal reflux in infants and children are: Frequent or recurrent vomiting. Frequent or persistent cough or wheezing. Refusing to eat or difficulty eating (choking or gagging with feeding). Heartburn, gas, abdominal pain, or colicky behavior (frequent crying and fussiness) associated with feeding. Regurgitation and re-swallowing. Complaining of a sour taste in their mouth Many other symptoms are sometimes blamed on gastroesophageal reflux, but much of the time, we really aren't sure whether reflux actually causes them. Other problems seen in young children and infants that may be blamed on GERD include: Colic Poor growth Breathing problems or wheezing Recurrent pneumonia Do Babies Outgrow Reflux? Yes. Most babies outgrow reflux. However, GERD can also occur in older children. In either case, the problem is usually manageable. How Is Reflux Diagnosed in Infants and Children? Usually, the medical history as told by the parent is enough for the doctor to diagnose reflux, especially if the problem occurs regularly and causes discomfort; but occasionally, further tests are recommended. They may include: Barium swallow or upper GI series. This is a special X-ray test that uses barium to highlight the esophagus, stomach, and upper part of the small intestine. This test may identify any obstructions or narrowing in these areas.

pH probe. During the test, your child is asked to swallow a long, thin tube with a probe at the tip that will stay in the esophagus for 24 hours. The tip is positioned, usually at the lower part of the esophagus, and measures levels of stomach acids. It also helps determine if breathing problems are the result of reflux. Upper GI endoscopy. This is done using an endoscope (a thin, flexible, lighted tube and camera) that allows the doctor to look directly inside the esophagus, stomach, and upper part of the small intestine. Gastric emptying study. Some people with GERD have a slow emptying of the stomach that may be contributing to the reflux of acid. During this test, your child drinks milk or eats food mixed with a radioactive chemical. This chemical is followed through the gastrointestinal tract using a special camera.

What Are the Treatments for Acid Reflux in Infants and Children? There are a variety of lifestyle measures you can try for acid reflux in babies and older children: For babies: Elevate the head of the baby's crib or bassinet. Hold the baby upright for 30 minutes after a feeding. Thicken bottle feedings with cereal (do not do this without your doctor's approval). Feed your baby smaller amounts of food more often. Try solid food (with your doctor's approval).

For older children: Elevate the head of the child's bed. Keep the child upright for at least two hours after eating. Serve several small meals throughout the day, rather than three large meals. Make sure your child is not overeating. Limit foods and beverages that seem to worsen your child's reflux such as high fat, fried or spicy foods and caffeine. Encourage your child to get regular exercise.

If the reflux is severe or doesn't get better, your doctor may recommend medication. Drugs to Lessen Gas in Babies and Children Drugs to lessen gas include: Simethicone such as Mylicon Gaviscon Drugs to Neutralize or Decrease Stomach Acid Drugs to decrease stomach acid include: Antacids such as Mylanta and Maalox Histamine-2 (H2) blockers such as Axid, Pepcid, Tagamet, or Zantac

Proton-pump inhibitors such as Nexium, Prilosec, Prevacid, Aciphex, and Protonix.

Researchers aren't sure whether decreasing stomach acid lessens reflux in infants. For the most part, drugs that decrease intestinal gas or neutralize stomach acid (antacids) are very safe. At high doses, antacids can cause some side effects, such as diarrhea. Chronic use of very high doses of Maalox or Mylanta may be associated with an increased risk of rickets (thinning of the bones). Side effects from medications that inhibit the production of stomach acid are uncommon. A small number of children may develop some sleepiness when they take Zantac, Pepcid, Axid, or Tagamet. Drugs to Improve Intestinal Coordination Drugs to improve intestinal coordination include: Propulsid. This drug was voluntarily withdrawn from the U.S. market in 2000 due to an association with abnormal heart rhythms; however, it is still available when prescribed under the guidance of a specialist in gastrointestinal diseases and can be very effective for treating childhood reflux. The drug works by increasing the pressure of the lower esophageal sphincter and increasing emptying of the stomach and the rate that food moves through the intestines. This helps reduce esophageal exposure to stomach contents. Reglan. This is another medication that helps speed up the digestion process. However, it is also associated with many side effects, some of which can be serious. Erythromycin. This is an antibiotic usually used to treat bacterial infections. One common side effect of erythromycin is that it causes strong stomach contractions. This side effect is advantageous when the drug is used to treat reflux. Surgery for Acid Reflux in Babies and Kids Surgery isn't often needed to treat acid reflux in babies and kids. When it is necessary, the Nissen fundoplication is the most often performed surgery. During this procedure, the top part of the stomach is wrapped around the esophagus forming a cuff that contracts and closes off the esophagus whenever the stomach contracts -preventing reflux. The procedure is usually effective, but it is not without risk. Discuss the potential risks and benefits of this operation with your child's doctor.