Gastroesophageal reflux disease (or GERD), affects 20% of American adults – that’s one in five people. But grownups aren’t the only ones who suffer with the symptoms of reflux. It is also extremely common in babies and children. In infants, it can cause vomiting and fussiness after feeding. And in older kids and teens, gastroesophageal reflux (GER) can lead to heartburn, stomach and chest discomfort.
Well-Being talked to Dr. Angela Shannon, Pediatric Gastroenterologist at GI Associates in Jackson about how reflux affects babies and young children and when parents should have an infant or child evaluated by a doctor to see if treatment is in order.
According to Dr. Shannon, not only is reflux common for infants and kids, all babies have some degree of reflux.
Reflux in Babies and Children
“The set up of babies little bodies is just the perfect storm for reflux,” explains Dr. Shannon. “It’s important to note that not all babies have problems with their reflux. But when babies routinely are irritable or cry after eating, if they are refusing to eat or are failing to gain weight, parents should consider seeing a doctor who can help determine the source of the problem.”
When it comes to treatment for babies, Dr. Shannon notes that conservative treatment usually works well.
Treating Reflux in Babies
“Parents can try some simple measures such as giving smaller feeds more frequently, burping them more often, leaving them at an upward angle for at least 20-30 minutes after meals, and addressing constipation issues,” Dr. Shannon continues. “Sometimes, changing bottles or nipple types may help. While it’s not harmful to try switching formulas, it’s important to remember that reflux is usually just that – a reflux problem, not a formula problem.”
“In children, it’s important to monitor diet and try to limit or avoid foods that exacerbate the reflux process, i.e., acidic foods/drinks, sauces, caffeine, even too much mint or chocolate. Sometimes, reflux is the temporary aftermath of an infection and you’ll notice your child has more reflux after being sick. In both babies and children, medications that block acid may be necessary. This is especially true when the reflux causes discomfort or pain or if your child’s appetite is negatively affected,” adds Shannon. “You really should have your child evaluated if pain complaints from reflux become a recurrent issue, if appetite is negatively affected, or if your child is losing weight or not gaining weight appropriately. Also, if the reflux is disrupting your child’s activities or sleep, have them evaluated.”
Symptoms of Reflux
Gastroesophageal reflux disease occurs when there is damage to the esophagus or stomach due to acid reflux. Without tissue damage, it is just GER. Common reflux symptoms include throat pain, chest pain, or sometimes just stomach pain in general. In babies, fussiness with back arching/ writhing can indicate a reflux problem. Obvious signs of reflux are vomiting, “spitting up,” or having wet burps.
Treating Reflux in Kids
At times, conservative treatment may not be enough to deal with reflux issues and in children who are uncomfortable or in pain and/or have poor weight gain due to reflux, medications may oftentimes be helpful. Common medications used to treat reflux include ranitidine (Zantac) and famotidine (Pepcid) – which are used to block the acid from working – and other medications, such as lansoprazole (Prevacid), omeprazole (Prilosec), esomeprazole (Nexium), and several others like them which are used to stop the acid pumps from producing so much acid. All can be used in infants and children, appropriately dosed based on size.
Well-Being asked Dr. Shannon if there are risks to children of long-term use of medications for acid reflux.
“In children there is minimal risk with long-term use – in fact usually, there is no need for long-term use to begin with,” explains Shannon. “However, some things to monitor include certain electrolytes and it is also not a bad idea to watch liver enzymes (both of which involve blood work). You want to be sure your doctor is one who uses anti-reflux medicines judiciously, no matter how small the risk of side effects may be.”
Dr. Shannon notes that for parents giving their children OTC medications for reflux, as long as they are following the product’s written instructions and not using longer than recommended, it should be fine. However, she stresses that a child should be evaluated by a doctor any time reflux symptoms are persistent or recurrent (especially if this occurs despite medicines). He or she may have other conditions that can mimic reflux and require different management.
A Word of Advice
Usually simple reflux in babies and children is not a serious problem and can be easily managed,” adds Dr. Shannon. “But oftentimes, it is best to have your child evaluated, even for simple reflux, in case there are other conditions such as anatomic abnormality, bacterial infection, or allergy inflammation masquerading as reflux that need to be identified. The good news is treatment is available and there is no reason for your child to have to suffer.”
Angela Shannon, M.D., Pediatric Gastroenterologist at GI Associates in Jackson, received a Bachelor of Science with a major in Biology from Millsaps College. She received her Doctor of Medicine from the University of Mississippi School of Medicine and completed her Pediatric Internship and Residency at University of Mississippi Medical Center. Dr. Shannon finished her clinical fellowship in Pediatric Gastroenterology and Nutrition at Cleveland Clinic Children’s Hospital. She is board certified in Pediatric Gastroenterology and General Pediatrics.