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Gastroesophageal Reflux Disease—Infant

Authors:
  • Patricia Griffin Kellicker, BSN
Publication Type:

Condition

Gastroesophageal Reflux Disease—Infant

(GERD—Infant; Chronic Heartburn—Infant; Reflux Esophagitis—Infant; Gastro-oesophageal Reflux Disease—Infant; GORD—Infant; Reflux—Infant)

See also:

Definition

Gastroesophageal reflux (GER) is a back up of acid or food from the stomach to the esophagus. The esophagus is the tube that connects the mouth and stomach. GER is common in babies. It causes them to spit up. Most babies outgrow GER within 12 months.

After 18 to 24 months esophageal harm and more symptoms may point to gastroesophageal reflux disease (GERD). GERD is the regular flow of acid to the esophagus. GERD needs to be treated to avoid worse problems.

Gastroesophageal Reflux Disease.

Food and acid back up into the esophagus from the stomach.

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Causes

The lower esophageal sphincter (LES) is a muscular ring between the esophagus and the stomach. It relaxes to let food pass into the stomach, then closes shut to prevent it from backing up. With GERD, the ring does not close as tightly as it should. This causes acid reflux, a burning feeling below the breastbone.

The following things contribute to GERD:

  • Increased relaxation of the LES
  • Problems with LES muscle tone
  • Problems with the nerves that control the LES
  • Delayed emptying of the stomach
  • Genetics and family history

Risk Factors

Things that may raise a baby's chance of GERD include:

Symptoms

GER is very common in the first year of life. Talk to the doctor if GER symptoms get worse or do not get better by 18 months.

Symptoms may include:

  • Spitting up or vomiting
  • Not growing or gaining weight
  • Refusing to feed or having trouble feeding
  • Irritability or fussiness during or after feeding
  • Arching of back or other movements during or after feeding
  • Regurgitation or bloody vomit
  • Breathing problems, including during sleep
  • Problems swallowing
  • Having a lot of respiratory problems
  • Cough, wheezing, or hoarseness
  • Disturbed sleep
  • A lot of crying

Diagnosis

The doctor will ask about symptoms and health history. A physical exam will be done. A pediatric gastroenterologist may need to be seen. This is a doctor who focuses on problems of the stomach and intestines.

Images of the stomach and esophagus may need to be taken. They may be done with a biopsy. Images can be taken with:

Other tests may include:

  • 24-hour pH monitoring—a probe is put in the esophagus to keep track of the acid in the lower esophagus
  • Short trial of medicines—GERD can be caused by different issues. If a medicine works or does not work it can help the doctor figure out what might be causing GERD.

Treatment

The goal of treatment is to prevent or heal damage to the esophagus and get rid of symptoms. Treatment options include the following:

Prevention

GERD cannot be prevented.

Lifestyle Changes

Lifestyle changes can help ease symptoms. The doctor may suggest:

  • Trying a hypoallergenic formula for 1 to 2 weeks. This formula does not have items linked with common allergic reactions.
  • Give small feedings often.
  • Thickening the formula or milk with rice, cereal, or another thickening agent.
  • Using a different pre-thickened formula.
  • Burping the baby more often. For example, burp the baby after they have eaten an ounce and 1 to 2 hours after being fed.
  • Making sure the baby is in an upright position during feeding. Keep the baby upright for 30 minutes after being fed.
  • Keeping a diary of the baby's symptoms.
  • Changing the baby's sleeping position. These positions depend on the baby's age. Young babies should always be placed on their back due to the risk of sudden infant death syndrome.
  • Keeping the baby away from secondhand smoke.

Lifestyle Changes

Lifestyle changes can help ease symptoms. The doctor may suggest:

  • Trying a hypoallergenic formula for 1 to 2 weeks. This formula does not have items linked with common allergic reactions.
  • Give small feedings often.
  • Thickening the formula or milk with rice, cereal, or another thickening agent.
  • Using a different pre-thickened formula.
  • Burping the baby more often. For example, burp the baby after they have eaten an ounce and 1 to 2 hours after being fed.
  • Making sure the baby is in an upright position during feeding. Keep the baby upright for 30 minutes after being fed.
  • Keeping a diary of the baby's symptoms.
  • Changing the baby's sleeping position. These positions depend on the baby's age. Young babies should always be placed on their back due to the risk of sudden infant death syndrome.
  • Keeping the baby away from secondhand smoke.

Medicines

For most people treatment starts with making lifestyle changes. Medicine may be given if the GERD does not get better. The medicine can help reduce acid in the stomach and help the esophagus heal. Medicine options may include:

  • H-2 blockers
  • Proton pump inhibitors

Surgery

Surgery or endoscopy may be recommended if the GERD is severe.

The most common surgery is called fundoplication. Part of the stomach is wrapped around the stomach valve to make it stronger. It should prevent stomach acid from backing up into the esophagus. This surgery is often done through small incisions in the skin.

RESOURCES:

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CANADIAN RESOURCES:

References

  • Acid reflux (GER & GERD) in infants. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-infants.
  • Gastroesophageal reflux disease (GERD) in infants. EBSCO DynaMed website. Available at: http://www.dynamed.com/condition/gastroesophageal-reflux-disease-gerd-in-infants.
  • Rosen, R., Vandenplas, Y., et al. Pediatric gastroesophageal reflux clinical practice guidelines: joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gasteroenterology, Hepatology, and Nutrition. Journal of Pediatric Gastroenterology and Nutrition, 2018; 66 (3): 516-554.

Contributors

  • Chelsea Skucek, MSN, BS, RNC-NIC
Last Updated:
2022-08-01

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This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.