Acid reflux in children

It is common for infants to regurgitate a little after meals. This is called gastroesophageal reflux, and often doesn't require treatment.

Gastroesophageal reflux (GER) is the most common oesophageal condition in children of all ages. It is the process of gastric contents passing back into the oesophagus due to the momentary relaxation of the ring of muscle fibres at the bottom of the oesophagus (called the lower oesophageal sphincter).

Why does GER occur?

When your child eats or drinks, swallowed material passes down the throat to the stomach through the food pipe, which is also known as the oesophagus.

Once it reaches the stomach, the lower oesophageal sphincter will tighten in order to prevent the food or liquids from moving back up the oesophagus. If this sphincter does not function well, relaxes abnormally, or weakens, then stomach acid can leak back into the oesophagus.

GER is usually resolved by gravity, peristalsis and neutralisation of the acid by the act of swallowing saliva. These protective mechanisms decrease during sleep.

On average, most infants will outgrow GER by the time they are a year old.

However, it is important to be aware that reflux can still occur in older children. If your child suffers from reflux, you will need to monitor him/her.

It is a good idea to keep a diary of your child's reflux episodes to determine the frequency and severity. Keep track of foods that have been consumed as well, so that you can identify if there are any that may stimulate your child to have a reflux episode.

If your child often suffers from reflux or if the discomfort is not manageable, bring him/her for a consultation with your paediatrician.

Gastroesophageal reflux disease

Excessive GER can lead to complications, and if this occurs, the child is said to have gastroesophageal reflux disease (GERD), which is a chronic digestive disease in which stomach acid, or sometimes even bile, flows back into the oesophagus.

This will result in symptoms like abdominal pain and heartburn, which are both common digestive conditions.

Factors that can worsen the effects of GER include the frequency and duration of exposure from GER episodes, the acidity of the stomach acids, and the susceptibility of the oesophagus to damage.

In the case of constant and/or excessive GER, the lining of the oesophagus can be irritated and badly damaged.

If the symptoms persist, seek immediate medical attention as constant episodes of GER can cause the oesophagus to become inflamed (oesophagitis).

Over time, the inflammation will erode the oesophagus, causing complications such as bleeding, scarring, and abnormal narrowing of the oesophagus.

Breathing problems may also result if refluxed material enters into the lungs. Such children may also have poor weight gain.

Check for these symptoms, which may indicate signs of GERD:

  • Chest pain
  • Upper abdominal pain
  • Burning or "acidic" sensation in the throat
  • Refusing to eat
  • Poor sleep, frequent waking: When a child is sleeping and his head isn't elevated, this allows the contents of the stomach to press against the lower oesophageal sphincter, which may cause it to open. When stomach contents are refluxed into the oesophagus, a coughing and choking sensation may be felt, which in turn can make sleeping more difficult.
  • Frequent chest problems such as wheezing or infections that do not respond easily to the usual treatment.
  • Vomiting blood or passing blood in their stool.
  • Poor weight gain

Treating children the natural way

Remember to consult your child's paediatrician if GER-related symptoms occur on a regular basis, or if GER causes your child discomfort. Your child's paediatrician may be able to recommend some simple steps to avoid it.

In most cases, lifestyle, feeding and sleeping modifications help considerably. You may want to try the following:

For babies/young children:

  • Elevate the head of the baby's crib.
  • Hold the baby upright for 30 minutes after feeding.
  • Change feed quantity and/or feeding schedules - frequent small meals rather than a single large meal.
  • Try thickened milk formula or solid food (with the approval of your child's paediatrician).

For older children:

  • Elevate the head of the child's bed.
  • Keep the child upright for at least two hours after eating.
  • Serve several small meals throughout the day, rather than a few very large meals.
  • Limit high-acid foods and carbonated beverages.
  • Encourage your child to get regular exercise as obesity worsens reflux.

If a combination of physical positioning and dietary changes is not effective, your child's paediatrician may recommend treatment with drugs. These drugs can be used to lessen the build-up of gas in the stomach, neutralise or decrease stomach acids, and improve intestinal coordination.

However, in severe cases, surgery could be considered as a last resort. The decision to go ahead with surgery is one that needs very careful consideration with your child's doctor in order to ensure that the benefits outweigh the risks.

The success of surgery varies from case to case as the results can be influenced by many factors.

Prof Dr Christopher Boey Chiong Meng is a professor of paediatrics and consultant paediatric gastroenterologist. This article is courtesy of the Malaysian Paediatric Association's Positive Parenting Digestive Health Initiative For further information, please visit www.mypositiveparenting.org. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader's own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

Facts to remember

  • GER occurs when stomach contents back up (reflux) into the oesophagus. In most cases, infants grow out of it with no complications.
  • Early diagnosis is important to prevent complications.
  • Treatment will depend on your child's symptoms, age and the presence of complications. They usually include lifestyle changes or prescription medicines, and in some cases, surgery.
  • Keep a diary. Take notes and record when the GER symptoms occur to see if there's a pattern. Do the symptoms occur after your child has eaten certain foods, or carried out certain activities? If so, you'll know which foods or activities are alright for your child, and which ones to avoid.
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