Children May Experience Gastroesophageal Reflux
Gastroesophageal reflux, or GERD, can strike even the youngest person. Just ask Priscilla Dunstan.
When her newborn son screamed all day and night, relaxing only when she carried him upright in her arms, his physician told her he had colic, a common condition among infants that tends to disappear by the age of 18 months.
But her baby did not get better, because, as it turned out, he suffered from GERD, a more serious gastric condition which often plagues adults.
"He kept on crying going into the four-month period,” she reports. “He was screaming all the time."
Colic is a normal physiologic process that can occur throughout the day in healthy infants and children. Most episodes are brief and are typically confined to the lower esophagus, explains Dr. Aeri Moon of Weill Cornell Medical College in New York City.
However, colic can worsen and become GERD when the stomach's contents move into the upper esophagus.
While its prevalence has been noted among adults in recent years, GERD is frequently overlooked in youngsters, despite the fact that it affects as many as 7 million children, according to the Pediatric/Adolescent Gastroesophageal Reflux Association.
"GERD is a serious problem,” says Dr. Moon. “It's a big deal."
Almost half of babies under three months of age will have GERD-like symptoms, which include spitting up and gas.
Often the condition can be confused with colic, says Dr. Moon, but these symptoms usually subside between the ages of 15 months and 18 months. During this time, as long as the baby is gaining weight and is happy and sleeping, parents need not be alarmed.
"However, if your baby doesn't outgrow vomiting, or if he or she has begun to associate eating and pain and is starting is develop eating disorders," Dr. Moon advises that it is time to seek a pediatrician's help to see if your child is suffering from GERD.
Other possible GERD symptoms in young children include irritability, excessive crying, poor sleep patterns, coughing, sore throat, or even pneumonia.
Between 50 percent and 80 percent of GERD cases are caused by the relaxation of the lower esophageal sphincter (LES), which separates the esophagus from the stomach and stays closed, except when someone swallows or burps.
No one knows exactly why this muscle loses resiliency, allowing the acidic contents of the stomach into the upper esophagus, but coughing, having a lot of food in the stomach, pressure on the abdomen when trying to ease constipation, or obesity can all be contributing factors.
Diagnosing GERD first involves eliminating other conditions with similar symptoms, such as testing for milk or food allergies, colic, or inflammation of the esophagus, and finding out if there is a family history of GERD.
Further tests include screening of the esophagus and a test that measures acidity in the esophagus.
If a young child has GERD, therapy includes introducing a dairy-free diet and/or a hypoallergenic baby formula. Overfeeding can also exacerbate the condition.
In older children, pediatricians recommend modifying the diet to avoid foods that trigger GERD symptoms. These include citrus drinks, chocolate, tomato-based foods, caffeine, spicy foods, and peppermint. A child should also not lie down directly after eating.
There are also medications that can help control the disease, because they inhibit the production of acids, notes Dr. Moon. In rare cases, surgery that wraps the top of the stomach around the esophagus to strengthen the lower esophageal sphincter is recommended.
"GERD cannot be cured, but it can be treated," explains Dr. Moon.
Dunstan's son, now nine, has controlled his GERD through a careful diet, she says. He avoids dairy products and spicy foods, and, fortunately, does not like tomatoes.
In her exhaustive efforts to find out what was causing her baby so much pain, Dunstan, an accomplished musician and opera singer with a photographic memory for sound, was able to identify patterns in her son's crying that led her to link his screaming to his eating habits and to uncover his gastric problems.
That led to more research on her part and to her discovery of what she claims are the five initial sounds that young children make before beginning to cry hysterically.
Distinguishing these sounds allows a parent to anticipate the baby's needs, which both helps a troubled child and dramatically improves the bonding between a parent and child, claims Dunstan.
Always consult your child's physician for more information.
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GERD is often the result of conditions that affect the lower esophageal sphincter (LES).
The LES, a muscle located at the bottom of the esophagus, opens to let food in and closes to keep food in the stomach.
When this muscle relaxes too often or for too long, acid refluxes back into the esophagus, causing vomiting or heartburn.
Everyone has gastroesophageal reflux from time to time. If you have ever burped and had an acid taste in your mouth, you have had reflux.
The lower esophageal sphincter occasionally relaxes at inopportune times, and usually, all your child will experience is a bad taste in the mouth, or a mild, momentary feeling of heartburn.
Infants are more likely to have the lower esophageal sphincter (LES) relax when it should remain shut.
As food or milk is digesting, the LES opens and allows the stomach contents to go back up the esophagus. Sometimes, the stomach contents go all the way up the esophagus and the infant or child vomits.
Other times, the stomach contents only go part of the way up the esophagus, causing heartburn, breathing problems, or, possibly, no problems at all.
Some foods seem to affect the muscle tone of the lower esophageal sphincter, allowing it to stay open longer than normal. Such foods may include chocolate, peppermint, or high-fat foods.
Other foods increase acid production in the stomach, including citrus foods or tomatoes and tomato sauces.
Some infants and children who have gastroesophageal reflux may not vomit, but may still have stomach contents move up the esophagus and spill over into the windpipe. This can cause asthma, pneumonia, and possibly even SIDS (sudden infant death syndrome).
Infants and children with GERD who vomit frequently may not gain weight and grow normally. Inflammation (esophagitis) or ulcers (sores) can form in the esophagus due to contact with stomach acid.
These can be painful and also may bleed, leading to anemia (too few red blood cells in the bloodstream). Esophageal narrowing (stricture) and Barrett's esophagus (abnormal cells in the esophageal lining) are long-term complications from inflammation.
Heartburn, also called acid indigestion, is the most common symptom of GERD.
Heartburn is described as a burning chest pain that begins behind the breastbone and moves upward to the neck and throat. It can last as long as two hours and is often worse after eating.
Lying down or bending over can also result in heartburn. Symptoms may include:
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belching
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refusal to eat
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stomachache
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fussiness around mealtimes
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frequent vomiting
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hiccups
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gagging
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choking
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frequent cough
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coughing fits at night
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wheezing
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frequent upper respiratory infections (colds)
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rattling in the chest
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frequent sore throats in the morning
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sour taste in the mouth
The symptoms of GERD may resemble other conditions or medical problems. Always consult your child's physician for more information.
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