Acid reflux is a common gastrointestinal disorder, which means it is a digestive system problem. However, acid reflux is also called gastroesophageal reflux disease (GERD). Many children show certain symptoms of reflux during their first year of life, including coughing or vomiting. These symptoms can occur in infants who are healthy. However, infants who experience acid reflux after 1 year of age may have GERD. Recurrent acid reflux in children is one of the most common sign of GERD.
Reflux in Babies and Children
Reflux in babies is because of a poorly coordinated gastrointestinal tract. Many healthy infants experience GERD. Some infants, however, may have problems affecting their nerves, brain, or muscles. The causes of GERD in older children are mostly the same as those seen in adults. Anything that causes the muscular valve to relax between the stomach and oesophagus (the lower esophageal sphincter, or LES), or anything that raises the pressure below the LES may cause reflux or GERD (1).
Reflux Symptoms in Infants
In adults, some variables, including smoking, overeating, eating spicy or fried foods, consuming caffeine, carbonation, and drugs, can also lead to GERD. Childhood GERD signs are more intense than the mild stomach pain or infrequent spitting.
Reflux or GERD symptoms in Infants include:
- refusing to eat
- not gaining weight
- breathing difficulties
- having pain after eating
- recurrent vomiting at 6 months of age or older
Reflux symptoms in older kids and teenagers include:
- repeated vomiting
- poor growth
- refuse to eat
- difficulty swallowing
- bad breath
Long-term backflow of the stomach acid into the oesophagus can damage esophageal lining. This condition may lead to Barrett’s oesophagus becoming precancerous. If the disease is not managed efficiently, it can also lead to oesophagus cancer. Although this is uncommon in children.
Reflux Strategies for Infants
Reflux strategies depend on the severity of the disease. Doctors always advise parents, kids, and teens to begin with simple changes in their lifestyle.
There are several basic reflux reduction strategies in infants include:
- Feeding an infant with small and daily meals
- Hold infant upright for 30 minutes after feeding
- Not feeding infants with food that induces reflux
Reflux reduction strategies in older kids and teenagers include:
- eat smaller meals frequently
- eating three hours before bedtime
- avoid eating spicy foods
- avoid high-fat foods
- Lose excess weight (if heavy)
- avoid eating acidic fruits
- avoid carbonated beverages
- Elevate the head during sleep
- Avoid eating enormous meals
- Avoid wearing tight clothes
The following beverages and foods will make GERD worse in older kids and teenagers:
- spicy foods
- acidic drinks
- orange juice or oranges
- carbonated beverages
- tomato sauce or tomatoes
Foods that cause symptoms can, however, vary from person to person. People with GERD should continue to remove food from their diet to see if their symptoms are getting better. If they don’t, they can add the food back to their diet.
Related: herbal remedies for acid reflux.
Drugs to Treat GERD
Your child’s doctor can prescribe drugs such as antacid to help reduce the amount of acid produced by your stomach. Such drugs include:
- Histamine-2 (H2) blockers such as cimetidine (Tagamet) or famotidine (Pepcid)
- Proton-pump inhibitors such as esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), omeprazole-Sodium Bicarbonate (Zegerid), pantoprazole (Protonix), rabeprazole (Aciphex)
In April 2020, the Food and Drug Administration (FDA) proposed that all formulations of H2 blocker ranitidine (Zantac) be withdrawn from the U.S. market. Since it was found to contain a cancer-causing agent (2, 3).
Drugs that reduce intestinal gas or neutralise stomach acid (antacids) are mostly safe. Antacids can cause certain side effects at high doses, such as diarrhoea. Side effects of the drugs that block stomach acid production are rare. When they take nizatidine, Pepcid, or Tagamet, some children may experience sleepiness.
Related: heartburn management during pregnancy.
Surgery is not needed to treat acid reflux in babies and children. In adults with severe GERD, the most commonly performed surgery is fundoplication. They wrap the upper part of the stomach around the oesophagus during this surgery, forming a cuff that contracts and closes the oesophagus as the stomach contracts. Typically, the procedure is successful, but it is not without risk.
The Bottom Line
In many infants, the symptoms of reflux disappear when they are around a 1-year-old. This is because the LES (lower esophageal sphincter) becomes stronger. Trying some remedies, taking medications, making lifestyle changes, and diet changes will minimise reflux for children. Surgery is never performed by physicians as a cure for paediatric GERD. They usually reserve it to treat severe cases, such as esophageal bleeding or ulcers, which drugs and lifestyle changes can not manage. Always speak to your doctor before managing your child’s reflux symptoms.