Gastroesophageal Reflux Disease (GERD) in Infants or Children

It is common for infants to spit up after a meal, but frequent vomiting may be caused by GERD (gastroesophageal reflux disease), the upward movement of stomach content, including acid, into the esophagus and sometimes into or out of the mouth. Older children also can have GERD.

What Causes Reflux in Babies and Children?

Most of the time, reflux in babies is due to a poorly coordinated gastrointestinal tract. Many infants with the condition are otherwise healthy; however, some infants can have problems affecting their nerves, brain or muscles. According to the National Digestive Diseases Information Clearinghouse, a child's immature digestive system is usually to blame. They add that most infants grow out of GERD by the time they are 1 year old.

In older children, the causes of GERD are often the same as those seen in adults. Anything that causes the muscular valve between the stomach and esophagus (the lower esophageal sphincter, or LES) to relax, or anything that increases the pressure below the LES, can cause GERD.

Certain factors also may contribute to GERD, including obesity, overeating, certain foods, some beverages, and specific medications. There also appears to be an inherited component to GERD, as it is more common in some families than in others.

What Are the Symptoms of Gastroesophageal Reflux in Infants and Children?

The most common symptoms of gastroesophageal reflux in infants and children are:

Frequent or recurrent vomiting.
Frequent or persistent cough.
Refusing to eat or difficulty eating (choking or gagging with feeding).
Heartburn, gas, abdominal pain, or colicky behavior (frequent crying and fussiness).
Regurgitation and re-swallowing.

Many other symptoms are sometimes blamed on gastroesophageal reflux, but much of the time, we really aren't sure whether reflux actually causes them. Other problems seen in young children and infants that may be blamed on gastroesophageal reflux include:

Colic
Poor growth
Breathing problems
Recurrent pneumonia.

Will My Baby Outgrow GERD?

Yes. Most babies outgrow GERD. However, reflux can also occur in older children. In either case, the problem usually can be managed easily.

How Is GERD Diagnosed in Infants and Children?

Usually, the medical history as told by the parent is enough for the doctor to make a diagnosis of GERD, especially if the problem occurs regularly and causes discomfort; but occasionally, further tests are recommended. They may include:

Barium swallow or upper GI series. This is a special X-ray test that uses barium to highlight the esophagus, stomach and upper part of the small intestine. This test may identify any obstructions or narrowing in these areas.
pH probe. During the test, the patient is asked to swallow a long, thin tube with a probe at the tip that will stay in the esophagus for 24 hours. The tip is positioned, usually at the lower part of the esophagus, and measures levels of stomach acids. It also helps determine if breathing problems are the result of reflux.
Upper GI endoscopy. This is done using an endoscope (a thin, flexible, lighted tube and camera) that allows the doctor to look directly inside the esophagus, stomach and upper part of the small intestine.
Gastric emptying study. During this test, the child drinks milk or eats food mixed with a radioactive chemical. This chemical is followed through the gastrointestinal tract using a special camera. Some patients with GERD have a slow emptying of the stomach that may be contributing to the reflux of acid.