reflux happens when food and stomach acid flow from the stomach back into the
esophagus. The esophagus is the tube that carries food
from the mouth to the stomach. In adults, reflux is often called heartburn or
Reflux is common in babies and children, and it is
usually not a sign of a serious problem. Most babies stop having reflux around
1 year of age. A child who continues to have reflux may need treatment.
What causes reflux?
Reflux happens because of a
problem with the ring of muscle at the end of the esophagus. The ring of muscle is called the
lower esophageal sphincter, or LES. The LES acts like
a one-way valve between the esophagus and the stomach. When you swallow, it
lets food pass into the stomach. If the LES is weak, stomach contents can flow
back up into the esophagus.
In babies, this problem happens
digestive tract is still growing. Reflux usually goes away as a baby matures.
What are the symptoms?
It is common for babies to
spit up (have reflux) after they eat. Babies
with severe reflux may cry, act fussy, or have trouble eating. They may not
sleep well or grow as expected.
An older child or teen may have
the same symptoms as an adult. He or she may cough a lot and have a burning feeling in
the chest and throat (heartburn). He or she may have a sour or bitter taste in
If stomach acid goes up to the throat or into the
airways, a child may get hoarse or have a lasting cough. Reflux can also cause
wheezing, and it may hurt to swallow.
How is reflux diagnosed?
To find out if a child
has reflux, a doctor will do a physical exam and ask about symptoms. A baby who
is healthy and growing may not need any tests. If a teen is having symptoms,
the doctor may want to see if medicines help before doing tests.
If a baby is not growing as expected or treatment doesn't help a teen,
the doctor may want to do tests to help find the cause of the problem. Common
A barium swallow, which is a series of
X-rays that shows the esophagus and
which lets the doctor look at the esophagus.
pH test, which measures how much acid is in the
How is it treated?
Most babies stop having
reflux over time, so the doctor may just suggest that
you follow some steps to help reduce the problem until it goes away. For
example, it may help to:
Burp your baby a few times during each feeding.
Keep your baby upright for 30 minutes after each feeding. Avoid a "car seat
position," because sitting can make reflux worse in babies.
feeding too much at one time. Give your baby smaller meals more
Thicken your baby's formula with a small amount of rice cereal if your doctor recommends it.
Keep your baby away from smoky areas.
For older children and teens, it may help to:
Avoid large meals before
Raise the head of your child’s bed 6 in. (15 cm) to 8 in. (20 cm). Using
extra pillows does not work.
Have your child stay upright for 2 to
3 hours after eating.
Serve 5 or 6 small meals instead of 2 or 3
Limit foods that might make reflux worse. These include
chocolate, sodas that have caffeine, spicy foods, fried foods, and high-acid
foods such as oranges and tomatoes.
Keep your child away from smoky
If these steps don't work, the doctor may suggest
medicine. Medicines that may be used include:
Antacids, such as Mylanta and Maalox.
Antacids neutralize stomach acid and relieve heartburn. You can buy these
without a prescription. But they are not usually recommended for long-term use.
H2 blockers, such as
cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid), and ranitidine (Zantac). H2 blockers reduce the amount of
acid in the stomach. You can buy some of these without a prescription. For
stronger doses, you will need a prescription.
Proton pump inhibitors, such as esomeprazole (Nexium), lansoprazole (Prevacid), and
omeprazole (Prilosec). You can buy some
proton pump inhibitors without a prescription.
Horvath A, et al. (2008). The effect of thickened-feed interventions on gastroesophageal reflux in infants: Systematic review and meta-analysis of randomized, controlled trials. Pediatrics, 122(6): e1268–e1277.
Khan S, Orenstein SR (2011). Gastroesophageal reflux disease. In RM Kliegman et al., eds., Nelson Textbook of Pediatrics, 19th ed., pp. 1266–1270. Philadelphia: Saunders.
Kumar Y, Sarvananthan R (2008). GORD in children, search date August 2007. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
Orenstein SR, et al. (2009). Multicenter, double-blind, randomized, placebo-controlled trial assessing the efficacy and safety of proton pump inhibitor lansoprazole in infants with symptoms of gastroesophageal reflux disease. Journal of Pediatrics, 154(4): 514–520.
Sundaram S, et al. (2011). Gastroesophageal reflux section of Gastrointestinal tract. In WW Hay et al., eds., Current Diagnosis and Treatment: Pediatrics, 20th ed., pp. 595–596. New York: McGraw-Hill.
ByHealthwise Staff Primary Medical ReviewerJohn Pope, MD - Pediatrics Specialist Medical ReviewerChuck Norlin, MD - Pediatrics
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