Gastroesophageal Reflux in Infants HF#5749



GERD (gastroesophageal reflux disease) occurs when stomach contents back up into the esophagus.  This is often called reflux or heartburn.

 

Cause

 

Reflux is often caused when the muscle between the esophagus and the stomach does not work well.  When this muscle is working as it should, it opens when food or fluid is swallowed.  This allows the food to pass from the esophagus into the stomach.  At other times, it remains tightly closed to prevent stomach contents from moving back into the esophagus.  

 

When an infant has reflux, two things can happen.

 

• The muscle does not close tightly enough to prevent stomach contents from moving, or refluxing, back into the esophagus.
• The muscle relaxes at the wrong time.  If this happens, stomach contents go up into the esophagus.

 

Symptoms

 

The stomach makes acids that are needed to digest food.  These acids do not bother the stomach, but they do bother the esophagus.  The movement of stomach contents into the esophagus can lead to many symptoms.  The most common symptom of reflux in infants is vomiting.  Infants may also become fussy and have trouble eating.  In more severe cases, infants may not grow well.  Some may even have breathing problems such as wheezing, coughing, or pneumonia.

 

Diagnosis

 

Reflux is often diagnosed by symptoms alone.  X-rays may help find problems other than reflux, but they do not confirm reflux itself.  In an upper GI test, your child swallows barium.  X-rays are taken of your child’s esophagus, stomach and intestines while the barium travels through the body.  This test is done to check for causes of your child’s vomiting such as ulcers, twisting of the intestines, and reflux.

 

Treatment

 

There are many ways to treat reflux.

 

• Feed your child smaller amounts of food more often.  This keeps the stomach less full.  Therefore, it helps decrease vomiting.

 

• Keeping your infant upright for 30 to 60 minutes after feeding may help.

 

• Raising the head of the crib may help keep the stomach contents from going back into the esophagus.  Stomach contents are more likely to reflux when your infant is lying down.

 

Medicines can be prescribed to treat the symptoms.

 

• Antacids such as Tums®, Rolaids®, Maalox®, or Mylanta® may stop or help mild symptoms and are used as needed for quick relief.  They decrease stomach acid.  Antacids that contain alginic acid like Gaviscon® may be more helpful.  You can buy these over the counter.  They can be used with newer medicines for reflux.

 

• H2 blockers such as ranitidine (Zantac®), nizatidine (Axid®) and famotidine (Pepcid®) reduce the amount of stomach acid.  They decrease the backflow of stomach acid into the esophagus.  This helps to relieve symptoms.  When taken twice a day, these work well.  They are used to prevent the return of symptoms.

 

• Proton pump inhibitors (PPIs) such as lansoprazole (Prevacid®), pantoproazole (Protonix®), omeprazole (Prilosec®), rabeprazole (Aciphex®), and esomeprazole (Nexium®) are newer drugs than the H2 blockers.  These are used when symptoms cannot be controlled with H2 blockers.  These help control symptoms and prevent the return of symptoms.

 

Most infants get relief from their symptoms when the above measures are taken.  Please call the Pediatric GI Clinic at (608) 263-6420 or toll free at 1-800-323-8942, if:

 

• Your child is not getting enough relief.
• The prescribed medicines are not helping.
• You have any questions or concerns.

 

Most infants with reflux will outgrow this by 12 to 24 months of age.  These children most often do not have problems as adults.

 

The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.

Last Updated: 05/15/2013

Copyright © 05/15/2013 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#5749

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