GERD in children and infants

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It is common for children to experience heartburn or acid reflux occasionally. This is not necessarily a sign of GERD. In fact, it is fairly typical.

GERD is a more long-lasting and persistent condition. If a child has acid reflux more than twice a week for several weeks, they may have GERD.

Childhood GERD can cause the following symptoms:

• a painful burning sensation in the center of the chest
• regurgitation, which is when the stomach contents travel back upward into the esophagus or throat
• nausea
• vomiting
• chest or abdominal pain
• cough
• hoarseness or wheezing
• pain with swallowing

Infants and younger children may be unable to tell others about their symptoms. Parents or caregivers can look for signs such as:

• fussiness
• crying more than usual
• refusing to eat
• loss of appetite
• unusual neck or chin movements
• arching of the back
• poor growth or weight loss

GERD happens when the sphincter at the bottom of the esophagus does not close properly. This allows stomach acid to flow backward, irritating the esophagus.

A range of risk factors and underlying conditions can lead to childhood GERD, such as:

• exposure to secondhand smoke
• obesity, as this puts pressure on the stomach
• severe developmental delays
• neurological conditions, such as cerebral palsy
• hiatal hernia, which is when part of the stomach bulges through an opening in the diaphragm
• previous surgeries to correct esophageal atresia, which is a congenital anomaly
• certain medications, such as certain antihistamines, asthma medications, pain medications, and antidepressants

Trauma and GERD

Some research suggests that people with GERD tend to have high rates of mental health conditions, such as anxiety and depression. This has led some people to speculate that psychological trauma could contribute to GERD, as it can with other digestive conditions.

There is not much research on the role trauma plays in childhood GERD, though. More studies are necessary to understand whether there is a potential connection.

Doctors usually diagnose childhood GERD by reviewing the child’s symptoms and medical history. If the signs suggest GERD, they may not need to order any further tests to confirm the diagnosis. If they do order tests, these could include:

• Upper gastrointestinal (GI) endoscopy: This procedure involves using a flexible tube with a camera on the end to examine the esophagus and stomach.
• Esophageal pH monitoring: This test detects and measures acid levels in the esophagus over 24 hours.
• Upper GI series: This procedure uses X-rays and a chalky liquid known as barium to examine the esophagus, stomach, and small intestine.

A doctor may also assess the child for other conditions that could be causing the symptoms, such as:

• cow milk allergy
• celiac disease
• Helicobacter pylori infection

For some children, GERD may improve with lifestyle changes alone. In other cases, they may need medications or surgery.

Lifestyle changes

Lifestyle and dietary changes can ease GERD symptoms in adults, but there is less research on their impact in children. Still, it may help to try them.

Some changes that may help include:

• reducing or eliminating smoking in the child’s environment
• giving smaller meals
• avoiding spicy, minty, or high fat foods
• avoiding caffeine, including from chocolate
• ensuring the child does not lie down for at least 3 hours after meals
• helping the child maintain a moderate weight for their age and height
• safely elevating the child’s head while they sleep by putting blocks under one end of the bed

Do not elevate the child’s head using pillows, especially if they are very young.

Medications

If lifestyle and dietary changes do not help, a doctor may prescribe medications, such as:

• Antacids: These medications help reduce the acidity of the stomach’s contents, which may provide short-term symptom relief in older children or teens. However, doctors do not recommend long-term use, and antacids are not suitable for younger children. Follow the instructions on the box or speak with a pharmacist about how to use them.
• Proton pump inhibitors (PPIs): PPIs reduce stomach acid production. Doctors typically prescribe them for 4–8 weeks in children, but they may consider longer-term treatment in some cases. PPIs have some drawbacks, such as increasing the chance of certain infections, so it is important to weigh the benefits and risks.
• H2 blockers: These drugs also reduce the amount of acid the stomach makes. They also raise the risk of certain infections, though, as stomach acid helps kill germs.

Surgery

If symptoms are severe, a doctor may recommend surgery to treat childhood GERD, such as fundoplication. This keyhole procedure involves sewing the top of the stomach around the end of the esophagus, reducing reflux.

There is not enough research to support using natural or herbal remedies for GERD in children. Additionally, the natural treatments that may help adults are not necessarily safe for children.

That said, there are some foods and drinks that may help ease the symptoms, such as:

• Low fat milks: Milk is alkaline, which means it can help lower the acidity of stomach acid.
• Ginger tea: Ginger can help with nausea and indigestion. It also reduces pressure on the esophagus. To make it, caregivers can try putting a few slices of fresh ginger root in hot water.
• Chewing gum: Older children may find it helpful to chew gum, as this increases saliva production and reduces acid in the esophagus. Avoid minty flavors, though, as this can relax the esophageal sphincter.

Always check with a doctor before trying natural or complementary treatments, especially if a child is also taking medication.

Yes, in many cases, children grow out of GERD as they age and their digestive systems mature.

Infants often regurgitate or spit up food during the first year of life. In 95% of cases, they outgrow it by 15 months of age, and it rarely persists into the second year of life.

However, a small number of infants with frequent or forceful spitting up, distress, and weight loss may have childhood GERD. It is more common in children 2–3 years or older.

Caregivers should contact a doctor if their child has GERD symptoms. If a child also has any of the following symptoms, they should receive urgent medical help:

• difficulty breathing
• persistent refusal to eat or drink
• frequent, forceful, or projectile vomiting
• bloody vomit, which may resemble coffee grounds
• black or tarry stool
• signs of dehydration, such as a lack of tears, infrequent or dark urine, and, in babies, a soft spot on top the head

Here are some questions people often ask about GERD in infants and children.

How do I know if my baby has GERD?

An infant with GERD may:

• arch their back
• show unusual movements in their neck and chin
• choke, gag, or show other signs of difficulty swallowing
• be irritable or cry more than usual
• refuse to feed or eat
• vomit large amounts, have blood in their vomit, or produce vomit forcefully, known as projectile vomiting
• cough, wheeze, or have difficulty breathing
• be slow to gain weight

How is GERD treated in infants?

Lifestyle tips include avoiding exposure to secondhand smoke, burping a baby more often, changing their diet or holding them upright for 20–30 minutes after feeding. If these do not help, a doctor may recommend medication or surgery, in rare cases.

Occasional acid reflux is common in children, but GERD is less common. It occurs when stomach acid frequently enters the esophagus and causes irritation. This results in regular acid reflux, indigestion, or heartburn.

Doctors usually diagnose childhood GERD by reviewing symptoms and medical history, but they may also order tests. Treatment usually begins with lifestyle changes, and then medications may follow.

There is not enough research to support natural remedies for childhood GERD. A person may speak with a pediatrician to get advice on managing GERD that is appropriate for the child’s age and symptoms.