Gastroesophageal Reflux Disease in Children with Disabilities
(GERD—Child With Disabilities; Chronic Heartburn—Child With Disabilities; Reflux Oesophagi—Child With Disabilities; GORD—Child With Disabilities; Reflux—Child With Disabilities)
Gastroesophageal reflux disease (GERD) is the back-up of acid from the stomach to the esophagus. The esophagus is the tube that connects the mouth and stomach. GERD irritates the lining of the esophagus. It causes a pain in the belly and chest called heartburn. GERD needs to be treated to avoid other problems. GERD can happen at any age.
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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 lets the acid flow back into the esophagus. Specific problems that may cause GERD include:
- Problems with the nerves that control the LES
- Problems with LES muscle tone
- Problems with the muscle contractions that move food toward the stomach
- Abnormal pressure on the LES
- Increased relaxation of the LES
- Increased pressure within the belly
Conditions that cause disabilities and their treatment may lead to or worsen reflux.
Things that may raise a child's chance of GERD include:
GERD is not the same as reflux. Reflux, or spitting up, is common in infants. Most will outgrow reflux within 12 months.
Children with GERD may have:
- Chronic pain in chest and throat (heartburn)—most common symptom
- Problems swallowing or choking with feedings
- Breathing trouble during sleep
- Not wanting to eat or being restless or irritable while feeding
- More mouth secretions
- Regurgitation, vomiting, or ruminating—bringing up and re-chewing food that was already swallowed
- Bloody vomit
- Weight loss or poor weight gain
- Frequent respiratory problems
- Coughing, wheezing, or hoarseness
- Arching back while feeding
It may not be easy to see signs of GERD if the child can not talk.
The doctor will ask about symptoms and past health. A physical exam will be done. A specialist may need to be seen. This type of doctor focuses on diseases of the stomach and intestines.
Images may need to be taken of the stomach and esophagus. This can be done with:
Other tests may help to find cause or guide treatment. 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—medicines can treat different causes of GERD. If a medicine works or does not work it can help the doctor understand the cause
There are three goals for treatment. The first is to prevent injury to the esophagus. The second is to make sure the child is eating enough. The third goal is to keep the backed up food and acid from getting into the lungs.
- Having kids eat smaller meals more often during the day
- Having children sit up if possible during meals or feedings
- Having kids stay sitting up for at least 30 minutes after meals if possible
- Not eating within 2 to 3 hours before bedtime
Every child is different. Ask the doctor if these steps would be helpful and learn about the best treatment plan. Options include:
GERD cannot be prevented.
Medicines can help decrease acid in the stomach and help the esophagus heal. Options may include:
- H-2 blockers
- Proton pump inhibitors
Many of these are over-the-counter medications that are available in liquid or powder form.
- Gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD) in children and adolescents. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/ger-and-gerd-in-children-and-adolescents/Pages/facts.aspx. Accessed January 28, 2021.
- Gastroesophageal reflux disease in infants. EBSCO DynaMed website. Available at: http://www.dynamed.com/topics/dmp~AN~T116575/Gastroesophageal-reflux-disease-GERD-in-infants. Accessed January 28, 2021.
- Pediatric GE reflux clinical practice guidelines. J Pediatr Gastroenterol Nutr. 2001;32:S1-S31.
- Chelsea Skucek, MSN, BS, RNC-NIC
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