gastro esophageal reflux

HEARTBURN & CHILDREN:

Gastroesophageal Reflux, commonly known to all as heartburn is common among adults but can also happen in kids and babies.

The term Gastroesophageal refers to the stomach and the esophagus (the muscular tube that carries food and liquids from the mouth to the stomach). And the term Reflux means to flow back or return. So, in simple terms Gastroesophageal Reflux is a condition where the food and the acid from the stomach goes back into the esophagus causing an uncomfortable feeling that we all know as heartburn.

While heartburn or GER can happen at any age, it’s a common problem in children and is usually a temporary problem. And reflux that happens a lot can lead to esophagus damage and is then known as Gastroesophageal Reflux Disease (GERD). GERD is more serious health issue and usually needs medical treatment

WHAT CAUSES REFLUX IN CHILDREN?

Reflux in children is often caused because of problems with a ring of muscle that separates the esophagus from the stomach. This ring of muscle called the lower esophageal sphincter opens to let food into stomach and then closes to keep the food confined in the stomach. GER happens when this ring of muscle relaxes too often or too long or when it doesn’t close as it should. Acid from the stomach goes back into the esophagus causing heartburn and other GER symptoms.

GER in children is often minor and is not a cause of concern, but in children who have GERD, reflux happens quite often and might cause some serious discomfort.

WHAT ARE THE SYMPTOMS OF GER AND GERD IN CHILDREN?

The symptoms of GER and GERD vary by age among children – among older children and teens, the symptoms may be similar to the symptoms among adults, whereas in younger children, the symptoms are similar to those seen among infants.

The most common symptoms are:

• Belching
• Frequent spitting up or vomiting, especially after meals
• Choking
• Nausea
• Coughing… too often, and sometimes coughing fits at night
• Fussiness around mealtimes, not wanting to eat
• Getting ear infections often
• Frequent hiccups
• Gagging
• Rattling sound in the chest
• Stomachache
• Wheezing
• Frequent cavities, especially in the back teeth despite good brushing

In babies and young children who are too young to describe their symptoms, mothers may notice signs of GER & GERD, such as:

• Wet burps or wet hiccups
• Irritability or inconsolable crying after eating
• Refusing to eat or eating only small amounts
• Poor growth, weight loss or not being able to gain weight as expected
• Arching of the back and abnormal movements of the neck and chin

WHAT ARE THE POSSIBLE COMPLICATIONS OF GER?

Babies experiencing GER usually outgrow it by the time they are one or two years old, but in some cases, the GER symptoms last for longer.

A persistent reflux of stomach acid into the esophagus can lead to the following issues:

• Breathing issue if the fluid enters the trachea, lungs or nose
• Bleeding inside the esophagus
• Scar tissue inside the esophagus that makes it hard for the child to swallow
• Pneumonia
• Repeated asthma attacks

These complications can make eating food difficult and painful for the child thereby interfering with proper nutrition, so, if the child is not gaining weight as expected or is losing weight, please consult your child’s pediatric gastroenterologist.

HOW IS GER DIAGNOSED IN CHILDREN?

Your child’s pediatric gastroenterologist will first examine your child and check his/ her health history and in order to diagnose reflux, the following tests would need to be done:

• Chest X-Ray: In most cases the first thing that that pediatric gastroenterologist does is to get a chest x-ray done to look for signs of aspiration. Aspiration causes breathing problems and sometimes lung infections and happens when the stomach contents spill into the lungs.
• Upper GI Series: An upper GI (gastrointestinal) series looks at certain organs of the child’s digestive system, such as, the esophagus, the stomach & the duodenum, to look for signs of liquid backing into the esophagus and for any upper digestive tract problems. The child, for this test, will swallow barium, a metallic liquid that coats the inside of the organs and helps it show on an x-ray.
• Milk Scans: Milk scans are a series of x-rays that tracks a special liquid as the child swallows it. These scans show whether the stomach is slow to empty liquids and also whether the refluxed liquid is being inhaled into the lungs.
• 24-Hour Impedance-ph Probe Study: This is probably, one of the most accurate ways to diagnose reflux and see how often it’s happening. The pediatric gastroenterologist takes a thin, flexible tube and inserts it through the nose into the esophagus. The tip of the tube is made to rest right above the esophageal sphincter for 24 hours and checks for acid levels in the esophagus and also reflux.
• Upper Endoscopy: The pediatric gastroenterologist uses a tiny fiber-optic camera to look at the esophagus, stomach and part of the small intestines. And in some cases, a small tissue sample of the lining of the esophagus may be taken to rule out or find out other related problems.

HOW IS GER IN CHILDREN TREATED?

The treatment of GER depends largely on the child’s age, general health, symptoms and the severity of the symptoms. In most cases, babies with reflux have no symptoms other than spitting up quite often and as long as these babies grow well without any other issues causes by reflux, they do not need treatment.

Doctors, might give children some basic medicines to decrease the amount of acid the stomach makes and ease the heartburn caused by reflux.

In some cases, babies with reflux might have other health conditions that makes them feel tired and these babies are not able to eat much, and when they do eat, they can’t keep a normal amount of formula or breastmilk in their stomachs before vomiting. In such cases, your pediatric gastroenterologist might recommend tube feedings. These tube feedings can be done with or in place of bottle-feeding or breastfeeding.

In severe or extreme cases, surgery is the treatment option – surgery is done to reinforce the esophageal sphincter. This reinforcement keeps the reflux from happening.

WHAT, YOU AS A MOTHER, CAN DO TO AVOID OR MANAGE REFLUX IN BABIES?

In babies, reflux is common, and to start with, you can make some minor and simple feeding changes that can help, such as:

• Avoid overfeeding the baby… smaller and frequent feedings can help reduce reflux.
• Burp your baby, both before and after feeding.
• After feeding the baby, hold the baby upright for 30 minutes. Avoid putting the baby in an infant seat after feeding as this position can make reflux worse.
• If you’re bottle-feeding, ensure that the nipple of the bottle is filled with milk, This keeps the baby from swallowing air while feeding.
• Speak to your health care provider before changing your baby’s diet or even your diet while breastfeeding.
• DO NOT ALLOW anyone to smoke around the baby as the smoke aggravates the reflux.
• Also, ensure that your baby’s diaper is not too tight as it can make reflux worse.

Reflux, in some babies, results in vomiting more often, and that can keep them from gaining weight. In such cases, speak to your pediatric gastroenterologist about calorie supplements.

To avoid reflux that happens at night among infants younger than a year old, ensure that the baby always sleeps on its back on a flat and firm surface.

IN CASES OF REFLUX IN OLDER CHILDREN, WHAT SHOULD YOU AS A MOTHER, DO?

Older kids get relief from reflux by avoiding certain foods and drinks that trigger GER symptoms, such as citrus foods, chocolate, caffeine drinks & food, garlic, onions, spicy foods, tomato-based foods & sauces and peppermint.

Pediatric gastroenterologists recommend raising the head of on older child’s bed by 6 to 8 inches to help with reflux that happens at night.

WHAT ELSE SHOULD YOU, AS A MOTHER, KNOW ABOUT GER?

If your child has GER, here are a few recommendations on what you should do:

• Encourage your child to eat smaller meals instead of three large meals in a day.
• If your child is overweight or obese, speak to your pediatrician about safe weight loss.

WHEN SHOULD YOU, AS A MOTHER CALL YOUR CHILD’S PEDIATRIC GASTROENTEROLOGIST?

You should immediately call your pediatric gastroenterologist if your child has GER and:

• is not showing growth,
• cries a lot more,
• refuses to eat by crying or arching away from the bottle or breast during feedings,
• chokes, coughs, or wheezes,
• vomits more than a few times in a day,
• shows blood in the poop.

You should immediately call your pediatric gastroenterologist or visit the ER if your baby throws up blood or bile (a green or yellow liquid)

WHAT ARE SOME POSSIBLE COMPLICATION OF REFLUX IN CHILDREN?

Some babies and children with reflux do not vomit at all. Instead, their stomach contents move up and spill over into the windpipe. This might cause the child to wheeze and it can even result in pneumonia.

Babies with reflux who vomit often do not gain weight and are not able to grow normally. This can result in inflammation known as esophagitis – a condition where inflammation damages the tissues of the esophagus and can cause painful, difficult swallowing and chest pain. It can also cause ulcers in the esophagus. These ulcers may also bleed, can be painful and can even lead to anaemia. This can result into long-term problems, such as esophageal narrowing and build-up of abnormal cells in the lining of the esophagus.