Pediatric gastroesophageal reflux disease (GERD) is a condition in which stomach acid flows into the esophagus of an infant or child, causing what is commonly known as heartburn. Without treatment, this backflow of acid can irritate and damage the esophageal lining.

It is common for stomach acid to flow up into the esophagus of infants, resulting in frequent spitting and throwing up. However, if the frequency exceeds the amount that doctors consider normal or there are other side effects, this may be a symptom of GERD.

If it goes untreated, GERD can have long-term effects on growth and development.

Keep reading to learn more about the symptoms of pediatric GERD, the treatment options, and when to seek help from a medical professional.

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GERD is a very common digestive disorder in which the contents of the stomach flow into the esophagus, irritating the esophageal lining and causing pain that people typically refer to as heartburn.

The esophagus is part of the digestive tract. It is a tube that delivers chewed food to the stomach. At the bottom of the esophagus is the esophageal sphincter, which opens and closes to allow food to enter the stomach. Although this sphincter is also supposed to prevent stomach acid from entering the esophagus, it can sometimes fail, causing heartburn or GERD.

Infants, particularly preterm infants, have an increased risk of this reflux of acid into the esophagus because of the physiological immaturity of their esophageal sphincter.

Gastroesophageal reflux (GER) is common in children under the age of 2 years. Research shows that GER occurs in approximately 50% of infants under the age of 2 months, 60–70% of infants aged 3–4 months, and 5% of 1-year-olds.

It is common for most infants to spit up frequently during their first few months of life, and this symptom is not a cause for concern. In fact, many infants will spit up multiple times daily, leading some to describe them as “happy spitters.”

However, GER can become GERD in infants when it persists in the long term, and this can affect weight gain, development, and quality of life. Approximately 95% of infants outgrow normal GER by 12 months of age. However, if these symptoms persist after 18 months of age, it is likely that GERD is the cause.

Pyloric stenosis is another condition that causes frequent vomiting in infants. However, unlike those with GERD, infants with pyloric stenosis will have forceful vomiting, called projectile vomiting. The reason for this is that the pylorus, the channel between the stomach and the intestine, becomes narrow. This condition requires surgical treatment.

Certain conditions increase the risk of GERD in infants and children. These include:

  • neurological impairment
  • obesity
  • anatomical abnormalities
  • family history of GERD
  • Barrett’s esophagus, which involves changes in the cells lining the lower part of the esophagus
  • esophageal cancer
  • congenital heart disease
  • abnormalities with the gastrointestinal tract
  • hernias in the diaphragm
  • genetic abnormalities

In addition to frequently spitting up, infants and children with GERD can have the following symptoms:

  • weight loss or lack of normal weight gain
  • irritability
  • excessive crying after feeding
  • anemia
  • bad breath
  • gagging at the end of feeding
  • abdominal pain
  • dental erosion
  • difficulty swallowing
  • a chronic cough
  • wheezing

It is important to know that these symptoms are not only specific to GERD but may also be the result of other infancy-related conditions, such as:

  • cow’s milk protein allergy
  • pyloric stenosis, in which food cannot enter the small intestine
  • malrotation, which causes underdeveloped intestines
  • overfeeding
  • tracheoesophageal fistula, which is an abnormal connection between two tubes in the body that causes foods and liquids to end up in the lungs
  • constipation

As several factors can contribute to the causes of these symptoms, it is important to consult a doctor to get a diagnosis and put an effective treatment plan in place.

If GERD goes untreated in an infant or child, they will likely have difficulty gaining weight, which leads to a lack of normal physiological and neurological development.

Some common diagnostic tests to determine whether an infant or child is experiencing GERD include:

  • Proton pump inhibitor (PPI) trial: Doctors try giving the individual PPIs, and if their symptoms disappear, this confirms the diagnosis.
  • Esophageal pH monitoring: This test measures how often stomach acid enters the esophagus.
  • Upper endoscopy: During this procedure, a doctor uses a camera to examine the inside of the esophagus.
  • Barium esophagram: This test uses barium and X-rays to provide images of the esophagus.
  • Esophageal manometry: This test evaluates muscle contractions in the esophagus while the person is swallowing to determine whether their esophagus is functioning properly.
  • Esophagogastroduodenoscopy (EGD) with biopsies: In an EGD, a doctor uses a camera to explore the esophagus, stomach, and first part of the small intestine to look for abnormalities. They may use a biopsy to determine whether the cells are abnormal.

Studies have investigated the usage of GERD PPIs, including lansoprazole, esomeprazole, rabeprazole, pantoprazole, and omeprazole, to help decrease crying, fussing, coughing, regurgitation, and vomiting.

However, the researchers concluded that PPIs are not any more effective than placebos in decreasing the symptoms associated with GERD. Therefore, doctors do not currently recommend PPIs as a treatment for infants with GERD.

Histamine 2 receptor antagonists, such as ranitidine, are an alternative treatment option.

Doctors may also suggest surgical treatment if other treatments prove ineffective. The most common surgical treatment is fundoplication, which involves wrapping and sewing the upper part of the stomach — called the fundus — around the esophageal sphincter. However, this procedure is invasive, so scientists and medical professionals are looking to develop other, less invasive treatments for infants and children.

Pediatric gastroesophageal reflux disease, or pediatric GERD, is a common digestive disorder that affects infants and children. This disease involves the backflow of stomach acid into the esophagus, causing irritation and pain known as heartburn.

GER is common in infants, but the vast majority of children outgrow it by the age of 1 year. If children display these symptoms past this age, they may have pediatric GERD.

The parents or caregivers of a child experiencing frequent spit-ups and problems with eating should consult a pediatrician.