Gastroesophageal Reflux in Older Children
GERD (gastroesophageal reflux disease) occurs when stomach contents back up into the esophagus. It 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 a child 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 to 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 irritate the esophagus. The movement of stomach contents into the esophagus can lead to stomach pain or pain in the chest. The feeling of food moving back up into the throat or mouth or a sour taste in the mouth are also common symptoms. Your child may have a poor appetite or may vomit often. Symptoms can occur any time during the day or night.
Diagnosis
Reflux is commonly 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. Other tests may be done if needed.
Treatment
The goal in treating GERD is to improve symptoms, heal irritation in the esophagitis, prevent it from coming back, and avoid future problems. There are many ways to treat reflux.
- Eat smaller meals more often rather than one big meal so the stomach will not be as full.
- Raise the head of the bed using 6-inch blocks to keep stomach contents from coming up into the esophagus while your child is lying down.
- Special diets are not needed to control the symptoms. Some older children find that certain foods make their symptoms worse. If this is the case for your child, these foods should be not be eaten.
- Avoid caffeine. It can increase the amount of acid in the stomach and cause symptoms to be worse.
Several 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 without a prescription. They can be used with newer medicines to treat GERD.
- 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 will help to relieve symptoms. Low doses of H2 blockers can be bought without a prescription. They work well for mild reflux. With a prescription, you can get larger doses. When taken twice each day, they work well and help 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 children get relief from their symptoms when the above measures are taken. Please call the Pediatric GI Clinic, (608) 263-6420, toll free: 1-800-323-8942 if:
- Your child is not getting enough relief.
- The prescribed medicines are not helping.
- You have any questions or concerns.
Symptoms of reflux can be controlled in most children. Children may have periods when they are symptom free and do not require any medicines. Symptoms may return from time to time and your child may need to use the medicines again.
The Spanish version of this Health Facts for You is #7089.
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: 10/20/2010
Copyright © 03/10/2010 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#5748
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