What to Do About Acid Reflux in Children

If your child has pain or discomfort after eating, is fussy after eating or has repeated complaints of sore throat with no clear cause or an unexplained cough, he or she may have gastroesophageal reflux or acid reflex.

The esophagus is the tube that takes food from the mouth to the stomach. With acid reflux, the contents of the stomach come back up into the stomach. If your child has persistent symptoms, or symptoms of acid reflux twice a week or more, your child is thought to have gastroesophageal reflux disease. Here's what to know:

Why do children develop acid reflux?

The lower esophageal sphincter is a valve mechanism that includes a muscle; it's located at the junction of the stomach and esophagus. When the child swallows, the sphincter relaxes, allowing food to pass from the esophagus to the stomach. The sphincter mechanism stays tight for the most part, allowing minimal movement of stomach content back into the esophagus. The tone of the sphincter may be lower if:

-- There is positive history of reflux in the family. Though the mechanism is not well elucidated, there could be a genetic reason.

-- Increased pressure on the abdomen from being overweight or obese.

-- Prior surgery to the esophagus or abdomen.

-- Developmental delay and muscle tone.

-- Neurological disorders like cerebral palsy.

-- Hiatal hernia, where the upper part of the stomach pushes up through the normal gap in the diaphragm.

-- Exposure to secondhand smoke.

-- Certain medications; for example, painkillers and antidepressants.

[See: How to Survive Acid Reflux -- Without a Pill.]

What are the symptoms of reflux?

Occasional reflux in children is not uncommon. However, GERD is reported in up to 25 percent of children, though this number is likely an over-estimate. The symptoms of reflux are variable; many children won't feel any overt symptoms. Still, here are some common signs:

-- Some children taste food in their mouth or notice a feeling of acid or a sour taste in the back of their mouth.

-- Older children may complain of heart burn -- a painful, burning feeling in the middle of the chest.

-- Bad breath.

-- Nausea or vomiting.

-- Problems or difficulty with swallowing.

-- Asthma that isn't responding appropriately to medication.

-- Unexplained wearing or enamel of the rear teeth.

-- Infants may have repeated spit ups, and some could develop distress, arching and crying with reflux.

How is reflux diagnosed in children?

Often, doctors diagnose acid reflux based on symptoms and medical history. If symptoms don't improve with diet, lifestyle modifications and medications, further tests may be required to evaluate the severity of reflux or whether other causes are at play.

Some of the tests that may be ordered include:

-- Upper GI: This involves the child drinking a liquid contrast called barium, which is used to define the anatomy of the esophagus, stomach and upper small intestine. In little children, the barium may be mixed with formula or milk.

-- Esophageal pH and impedance monitoring: A small spaghetti size tube is placed into the child's lower esophagus and measures the amount of acid or liquid in the esophagus. The lower part of the tube has a monitor that measures how much and how often acid refluxes up into the esophagus. The other side of the tube is connected to a recording device that records the measurements and is typically worn for a day.

-- Upper gastrointestinal endoscopy with biopsy: This involves passing a flexible tube by the doctor into your child's esophagus and then into upper small intestine. The tube has a fiber optic light source and camera. The endoscopy evaluates the lining of the esophagus, stomach and upper small intestine, and the doctor may also obtain tissue sample for analysis (biopsy).

[See: 10 Weird Things That Can Make You Poop.]

How can reflux be managed?

There are two aspects to reflux management: Lifestyle and diet management and medications.

The lifestyle and diet management include:

-- Less spicy and acidic foods, such as juices, caffeinated drinks and spicy items.

-- Small meals and lesser fatty meals.

-- Weight reduction if possible.

-- Staying upright for two to three hours after meals.

-- Sleeping at an angle; this involves raising the head end of the child's bed with block by 6 to 8 inches.

In little children and infants, diet and lifestyle changes aren't applicable.

If diet and lifestyle changes don't work, the doctor may choose to start medications. These include prescription medications and over-the-counter medications. Most children require short courses of treatment and can subsequently be managed with diet and lifestyle modification. The medications include:

-- Over-the-counter antacids.

-- H2 blockers that lower acid production.

-- Proton pump inhibitors, which work specifically on the acid pumps in the stomach to block acid production.

-- Medications that help empty the stomach better -- prokinetics.

[Read: Which Doctor Should I See for Digestive Issues?]

In most infants, the symptoms improve by six to eight months, when they're more upright and sphincter mechanisms improves. Some children with severe symptoms that don't respond optimally to medical management may require special surgery the tighten the sphincter. The surgery is performed by a pediatric surgeon.

Dr. Kadakkal Radhakrishnan, MBBS, MD (Peds), DCH, MRCP (UK), MRCPCH, FAAP, is a Pediatric Gastroenterologist and Hepatologist at Cleveland Clinic. Dr. Radhakrishnan has been on faculty in the Department of Pediatric Gastroenterology at Cleveland Clinic since June 2006. He also has joint appointment as Assistant Professor at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University. Dr. Radhakrishnan's areas of interest involve liver disorders in children, care of children after liver transplantation and small-bowel transplantation. He also has an interest in metabolic disorders involving the liver and care of gastrointestinal manifestations in children with metabolic disorders. Dr. Radhakrishnan, however, follows all types of pediatric gastroenterology problems in his clinic. He also performs upper and lower endoscopy and endoscopically places gastrostomy feeding tubes. In conjunction with Dr. Sumit Parikh from Pediatric Neurology, he runs the Cyclic Vomiting Syndrome Clinic for children. Dr. Radhakrishnan is a keen teacher involved in the teaching of medical students, residents and fellows. He was voted by the pediatric residents at Cleveland Clinic as Staff Teacher of the Year for 2007. Dr. Radhakrishnan's research areas include liver disorders and inflammatory bowel disease.