When it comes to gastroesophageal reflux, this condition can be experienced by infants as well as older kids and teens. The condition goes by many names including reflux, acid reflux and GER.
The Difference Between GER and GERD
Gastroesophageal reflux (GER) is stomach fluid that comes back up into the esophagus (throat). Sometimes it’s very slight and not bothersome. Other times it can cause discomfort. In babies this might look like fussiness. In older kids, it can be felt as fluid in the throat. It might cause their throat to burn, or it might not.
In babies, gastroesophageal reflux is often simply spitting up. Almost all babies spit up. The majority of babies are what we like to call “happy spitters.” They eat well and are healthy. Spitting up doesn’t bother them. In these kids, spitting up is more of a laundry problem than a health problem. Babies typically outgrow this by the time they’re 12-14 months old.
Gastroesophageal reflux disease (GERD) is more concerning. The term GERD is used for any fluid reflux into the esophagus that causes troublesome symptoms and/or complications that lead to health problems.
When a child is diagnosed with GERD, it means the condition keeps occurring, it could possibly affect your child’s growth, and it may require some medical intervention.
Below are tips we give to families of kids experiencing GER, as well as symptoms that could cause your pediatrician to refer your child to a specialist.
How to Help Infants with GER
- Avoid tobacco exposure. Babies who are exposed to secondhand smoke have an increased risk of reflux.
- For those babies who are breastfed, continue breastfeeding. It’s thought that breast milk has a protective effect on a baby’s regurgitation.
- Avoid overfeeding. Talk to your pediatrician about how much and how often you’re feeding your baby. Some babies don’t do well regulating their own eating. This can lead to overfeeding which can then lead to reflux.
- Keep an eye out for other symptoms. Watch for the following in your baby: Poor weight gain, fussiness, eczema, bloody stools. These could signal a potential food allergy. Talk to your pediatrician if your child is having these symptoms.
- Talk with your doctor before changing formulas. They’ll be able to help determine if switching formulas is the right next step to take.
- Ask your doctor about thickening your baby’s feeds. This helps some babies who have reflux. Because rice cereal can be constipating, I like to use oat cereal to thicken feeds. Talk to your pediatrician before thickening feeds, and they can help guide appropriate timing and amount.
- Try smaller, more frequent feeds.
- Hold your child upright after feeding. Aim for 20-30 minutes if possible.
- Always put your child to sleep on their back. Even a baby who has reflux should sleep on their back, not on their belly or side. Follow the same safe sleep practices that you would for a child without reflux.
How to Help Older Kids and Teens with GER
- Have your child keep a food diary. Diet is important when it comes to GER. What might cause one person to have reflux may not be the same for someone else. Keeping track of what your child eats and how it affects them can help you and your pediatrician see which foods cause the most problems.
- Avoid foods that can make reflux worse. This includes chocolate, peppermint, foods and drinks with caffeine, and acidic foods including soda, tomato sauce, tomato juice and orange juice. Sometimes foods high in fat can also make reflux worse since they tend to sit in the stomach longer. Talk with your pediatrician before making nutritional changes to make sure they’re ok with the plan.
- Don’t lay down right after eating.
- Talk to your pediatrician about weight management. Kids who adopt a healthy lifestyle and make good food choices sometimes see an improvement in their reflux.
- Avoid tobacco exposure, including both cigarette smoke and vaping. Those exposed to firsthand and secondhand smoke have an increased risk of reflux.
Your pediatrician may suggest acid suppression medications after or along with the above strategies.
When Your Child Might Be Referred to a Specialist
If your child is still struggling with symptoms related to reflux, the next step could be a referral to a specialist. This doctor is called a gastroenterologist; they specialize in conditions that affect the digestive system. They are often called GI (gastrointestinal) docs.
Babies and younger children might be referred to a gastroenterologist if they experience:
- Poor weight gain
- Bloody stools (after initial treatments do not lead to improvement)
- Fussiness (after initial treatments do not lead to improvement)
- Lethargy
Older kids and teens might be referred to a gastroenterologist if they experience:
- Difficulty or pain when swallowing food
- A feeling of food getting stuck during swallowing
- Weight loss
- Spitting up or vomiting blood
- Reflux at night where food comes out while they’re sleeping (look for food or fluid on their pillow that’s not drool)
- Initial medical treatment for heartburn isn’t working
- Forceful vomiting that happens outside of an acute illness and recurs or persists beyond a few days
Talk with your pediatrician if your child is experiencing any of the above symptoms.
When Would My Child Need Emergency Care?
If your child experiences any of the following, call your doctor immediately or take your child to the emergency room:
- In infants: Spitting up is more forceful vomiting, or they are vomiting bright green fluid
- In any age child: Vomiting blood or dark brown fluid (old blood)
A gastroenterologist will work with you to determine the cause of your child’s symptoms and treatments that are manageable for you and your child.
Gastroenterologist Daniel Mallon, MD, from our Division of Gastroenterology, Hepatology and Nutrition, contributed to this blog post.
