Feeding and Swallowing Clinic

Gastroesophageal Reflux

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What is Gastroesophageal Reflux?

Gastroesophageal reflux (GER) is a condition in which stomach contents back up into the esophagus (the tube between the stomach and throat) and/or the throat.  This happens when the muscles that separate the stomach and the esophagus are weak and do not close tightly.  When there is not a tight seal between the stomach and the esophagus, anything that is in the stomach can leak into the esophagus or throat.  This leaking can irritate the esophagus, causing a child to feel burning and discomfort.  If the stomach contents leak into the throat, a child will spit up.

What are the symptoms of GER?

Some of the most common symptoms associated with GER in infants and children are:

     
  • irritability and crying (due to discomfort and/or pain)
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  • frequent spitting up or vomiting
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  • poor sleep habits; frequent waking during the night
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  • "wet burp/hiccup" sounds

Other symptoms associated with GER that are not as common include:

     
  • swallowing problems; gagging; choking
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  • respiratory problems, such as wheezing or frequent episodes of pneumonia
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  • poor growth or weight loss

What can be done about GER?

Most babies who suffer from GER outgrow their reflux problems by the time they are about one year old.  In the meantime, special positioning and feeding techniques can be used to reduce the symptoms of reflux and make a child with mild GER more comfortable.  Some children who have more severe cases of GER may require medication or surgery to handle their reflux problems.

Positioning - A baby who has GER should never be positioned flat on his/her back.  The child should be kept as upright as possible during the day and should sleep at a 30 degree angle.  This sleeping position can be accomplished by placing a foam wedge in the baby's crib.

Feeding - Some specialists recommend that a baby with GER should be fed smaller meals more often throughout the day.  This results in less food in the stomach at one time and reduces the risk of reflux.  Thickening a baby's formula with cereal also makes it less likely that the food will back up into the esophagus or throat.

Medication - Doctors prescribe several types of medicine to reduce a child's GER symptoms.  These medications usually neutralize the acid in a child's stomach, decrease the amount of stomach acid that a child's body produces, or increase the movement of food through a child's stomach.

Surgery - In very few cases, GER does not respond to medication and does not resolve on its own.  Surgery may then be considered.  The most common surgery for children with GER is the Nissen fundoplication, which involves wrapping the very top of the stomach around the base of the esophagus.  This tightens the muscles that are weak and prevents the stomach contents from backing up into the esophagus or throat.

What should you do if you think your child suffers from GER?

It is extremely important to consult with your child's doctor if you believe that he/she has problems with reflux.  The doctor will be able to provide more specific information on this condition and can make appropriate recommendations for your child.

If you would like more information concerning pediatric GER:

American Pediatric Gastroesophageal Reflux Association
(617) 331-2238
Pediatric/Adolescent Gastroesophageal Association website
http://www.reflux.org

References

Klein and Delaney. (1994). Managing Gastroesophageal Reflux.  Tucson, AZ: Therapy Skill Builders.

Pediatric/Adolescent Gastroesophageal Association. "About Pediatric GER." (1999). Online. http://www.reflux.org. 3 August 1999.