Gastroesophageal Reflux in Young Children

Introduction:

Gastroesophageal reflux is the backwashing of stomach contents and stomach acid into the esophagus due to inappropriate relaxation of the lower esophageal sphincter (LES). Gastroesophageal reflux (GER) is also known as acid reflux or heartburn. If acid reflux causes damage to the esophagus, it is referred to as Gastroesophageal Reflux Disease (GERD).

Pediatrics, GER and GERD:

Many infants "spit-up." Approximately 50% of 0-3 month olds have at least one episode of Gastroesophageal reflux per day. This increases to a peak of 67% of infants at 4 months of age. (Department of Otolaryngology, University of Texas Medical Branch. 2000, October). It is estimated that 5 to 8 percent of young children develop Gastroesophageal Reflux Disease. This percentage rises considerably in young children with motor, neurological and developmental problems, estimated at 50-80 percent in those populations (Burns, 2003). Medical diagnoses associated with a higher incidence of GERD include: Down Syndrome, Cerebral Palsy, Autism, Rubinstein Taybi Syndrome, Cystic Fibrosis and Cornelia de Lange Syndrome. Premature infants are also more susceptible to GERD. Despite the prevalence in young children, the symptoms of GERD are often overlooked, or sometimes misdiagnosed as "colic."

Categories of Symptoms related to Pediatric Gastroesophageal Reflux Disease:

I. Pain

• Irritability


• Constant or sudden crying


• "Colic"


• Writhing: back arching, drawing up legs


• Abdominal pain above the belly button


• Chest pain or burning sensation in esophagus


• Sore throat


• Otalgia/ear pain

II. Vomiting

• Frequent spitting-up or vomiting (although some children with GERD spit-up minimally or have "silent" reflux where acid goes into the esophagus but does not result in vomiting. Silent reflux may cause more damage to the esophagus because the acidic stomach contents are not expelled.)


• Spitting-up more than one hour after eating


• Frequent burping/wet burping


• Difficulty burping


• Hematemesis/bloody vomit