Severe Acid Reflux in Children

Severe acid reflux in children occurs when acid and the contents of the stomach flow upward into the esophagus. Symptoms in children may include heartburn, gas, vomiting, poor feeding, coughing and weight loss. The Mayo Clinic estimates that about 17 million American children and adults suffer from acid reflux. Infants with the condition often improve before the age of 18 months old, but older children who develop the disorder may continue to experience symptoms throughout life. Treatment focuses on neutralizing or blocking stomach acids to prevent complications.

Causes

• In infants, acid reflux may result from a poorly coordinated or underdeveloped gastrointestinal tract. Older children usually develop acid reflux for the same reason as adults. In most causes of severe acid reflux, the lower esophageal sphincter malfunctions, allowing food and acid to move upward into the esophagus. The lower esophageal sphincter, or LES, is a ring of muscle that functions like a one-way valve in healthy children and adults. When this muscle is weak or relaxed, stomach contents can escape back into the esophagus, leading to acid reflux. The reason why this valve malfunctions is not always clear, but bending over, wearing tight clothing, carrying extra weight in the abdominal region and overeating may all trigger reflux in those with a weakened or relaxed LES.

Symptoms

• The symptoms of severe acid reflux in children may differ from those seen in adults. In young children and infants, acid reflux causes heartburn, excessive gas and abdominal pain, which may present as colic. Other common symptoms include frequent vomiting, coughing and regurgitation. Depending on the severity and frequency of acid reflux, chest pain, refusal to eat, weight loss, bad breath, gagging, hoarseness, frequent night waking, and recurrent sore throats, wheezing, ear infections and sinus infections may also occur.

Diagnosis

• In many cases, severe acid reflux in children is diagnosed based on reported symptoms and a physical examination. Sometimes, additional tests may be needed to confirm the diagnosis. A barium swallow, upper GI endoscopy, pH probe or gastric emptying study may be performed to look for esophageal narrowing or irritation. Blood and urine tests are usually ordered to rule out other causes of poor growth, weight loss and vomiting.

Treatment

• Treatment of severe acid reflux in children involves a combination of home remedies, medications and dietary changes. Elevating the head of the bed or crib during sleep, thickening bottle feedings with rice cereal, frequent burping and smaller meals may all help reduce symptoms. Dietary changes include limiting carbonated beverages, spicy foods, chocolate and citrus products. Over-the-counter or prescription medications can help neutralize stomach acid. Antacids, such as Maalox and Mylanta, and acid-blocking medications, including Zantac and Pepcid, are safe for use in children. Proton-pump inhibitors and Reglan may be prescribed. Surgery is rarely necessary in children, but a procedure called Nissen fundoplication is an effective treatment in severe and persistent cases.

Warning

• Severe acid reflux in children can cause significant complications. This is especially true in infants and toddlers. Frequent reflux can lead to inflammation of the esophagus, called esophagitis, which can interfere with feeding. Esophagitis may also cause bleeding and the formation of scar tissue, preventing normal swallowing. Lack of nutrition due to restricted eating or frequent vomiting can lead to malnutrition and poor growth, and infants and young children can develop respiratory complications if stomach contents are inhaled and enter the lungs. Frequent acid reflux also erodes tooth enamel, causing serious dental problems in older children.