Pediatric Gastroenterology

Gastroesophageal Reflux Disease in Pediatric Gastroenterology

Doctor examining a little girls abdominal area

Gastroesophageal reflux (GER) is a digestive problem that causes stomach juices, fluids, and foods to return to the stomach. When GER is an illness, it is known as gastroesophageal reflux disease (GERD). In children, it may be caused by immaturity of the lower esophageal sphincter.

Signs and Symptoms

The most common symptom is heartburn. While adults can easily tell when they have heartburn, children may not be able to tell. Pediatric patients with GERD cry a lot, and show decreased sleep and sleep disturbance. Other common symptoms in infants and young children include:

  • Vomiting
  • Typical crying or irritability
  • Apnea or bradycardia
  • Wheezing
  • Poor appetite that leads to poor growth or loss of weight
  • Recurrent pneumonitis
  • Water brash
  • Abdominal or chest pain
  • Chronic cough
  • A sore throat, hoarseness or laryngitis

Older children show all or some of the above signs as well as heartburn, halitosis, history of vomiting, unhealthy teeth, and regurgitation.


In most instances, physicians make a diagnosis by talking to the caregiver and examining the child. Occasionally, testing is required, and each test has its advantages and disadvantages. The most commonly used tests to determine GERD are:

PH Probe: A tiny wire with an acid sensor at its end is inserted into the nose down into the bottom of the esophagus. It is then left in place for about 12-24 hours. The sensor identifies when acid is refluxed from the stomach to the esophagus.

Technetium Gastric Emptying Study: A child is given milk that has been mixed with technetium, a fragile radioactive substance. It is then followed through the intestinal tract using a unique camera. This test helps in determining how long the milk/technetium stays in the stomach and if some of it ends up in the lungs.

Barium Swallow: A child is given barium. Barium is a chalky white liquid. An X-ray machine follows barium through the upper intestinal tract and allows doctors to see if there are any abnormal kinks, twists or narrowing of the digestive tract.

Endoscopy with Biopsies: This comprehensive test involves passing a flexible endoscope through the mouth into the esophagus, stomach then the duodenum. The endoscope allows the doctor to see any inflammation or irritation present. During endoscopy, children require a general anesthetic.

Is GERD serious?

Spitting up is normal in infants. As long as the child's growth is okay and is and not having other complications such as breathing problems, the condition does not require any treatment and will clear on its own with time.

However, the condition is regarded serious when:

  • Babies have inflammation or ulcers on their esophagus because of contact with stomach acid.
  • Babies vomit often leading to poor weight gain and growth.
  • Leads to respiratory problems
  • The ulcers may get painful and bleed, leading to anemia.


The aim of medical therapy for GERD is to decrease acid production and reduce the gastric emptying time. The end goal is to reduce the symptoms, rather not to cure the underlying disease, as it will resolve with time. A simple treatment is to thicken the baby's formula or milk with rice cereal, so to reduce its chances of being refluxed.

Other ways of managing GERD in an older child:

Dietary Changes: Avoid taking caffeine, carbonated drinks, peppermint, chocolate, tomato products, and other acidic foods such as citrus juices. Spicy foods and fried foods are known to worsen the symptoms. Pay close attention to what your child eats.

Lifestyle Changes: Have your child eat smaller and more frequent foods as opposed to large amounts of foods at once. In addition, raise the head of the child's bed about thirty degrees. Do not let them eat right before going to bed; let at least two hours to pass by. Take them for a walk and bathe them using warm water. Research has shown that dressing in loose clothing and losing weight may help in relieving GERD.


Most drugs prescribed break down or ease intestinal gas, improve internal coordination and lessen or improve intestinal coordination. Your doctor will prescribe the best drug for your child. It is very rare for a child with GERD to require surgery.