You shouldn't give your baby any medicines unless the doctor tells you to. If these don't help and your baby still has severe symptoms, then surgery might be an option. Pediatric gastroenterologists only use surgery to treat GERD in babies in rare cases.
They may suggest surgery when babies have severe breathing problems or have a physical problem that causes GERD symptoms. The information on this site should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health. What causes reflux and GERD in infants?
In babies who have GERD, the sphincter muscle becomes weak or relaxes when it shouldn't. How common are reflux and GERD in infants?
What are the symptoms of reflux and GERD in infants? GERD may also cause symptoms such as Arching of the back, often during or right after eating Colic - crying that lasts for more than 3 hours a day with no medical cause Coughing Gagging or trouble swallowing Irritability, especially after eating Poor eating or refusing to eat Poor weight gain, or weight loss Wheezing or trouble breathing Forceful or frequent vomiting NIH: National Institute of Diabetes and Digestive and Kidney Diseases How do doctors diagnose reflux and GERD in infants?
Common tests include Upper GI series , which looks at the shape of your baby's upper GI gastrointestinal tract. Your baby will drink or eat a contrast liquid called barium. The barium is mixed in with a bottle or other food. The health care professional will take several x-rays of your baby to track the barium as it goes through the esophagus and stomach.
Esophageal pH and impedance monitoring , which measures the amount of acid or liquid in your baby's esophagus. A doctor or nurse places a thin flexible tube through your baby's nose into the stomach. The end of the tube in the esophagus measures when and how much acid comes up into the esophagus. The other end of the tube attaches to a monitor that records the measurements.
Your baby will wear this for 24 hours, most likely in the hospital. Upper gastrointestinal GI endoscopy and biopsy , which uses an endoscope, a long, flexible tube with a light and camera at the end of it. The doctor runs the endoscope down your baby's esophagus, stomach, and first part of the small intestine.
While looking at the pictures from the endoscope, the doctor may also take tissue samples biopsy. A majority of babies have some form of GER in the first year. Symptoms of newborn acid reflux usually first show up between weeks 2 and 4.
They tend to peak around 4 months and begin to subside around 7 months, when baby begins to sit upright and take more solid foods. GERD treatment and home remedies for GERD are aimed not at curing the condition but at helping baby feel better until she outgrows her infant reflux.
Try following these tips:. Choking — i. If your baby seems to be choking during or after feedings, try the home treatments and remedies outlined above particularly feeding baby in an upright position and propping her up afterwards.
Nasal congestion can also be a symptom of infant GERD. In the meantime, if congestion is severe, try these tactics for stuffy nose relief. If your newborn projectile vomits in the first few weeks of life, keep an eye out for symptoms of pyloric stenosis , since it can sometimes be confused with GERD in infants. In addition to forceful vomiting at feedings, symptoms of pyloric stenosis include blood in the vomit, constant hunger, dehydration and constipation.
While rare, the condition does require diagnosis and treatment by a doctor. What to Expect follows strict reporting guidelines and uses only credible sources, such as peer-reviewed studies, academic research institutions and highly respected health organizations. Learn how we keep our content accurate and up-to-date by reading our medical review and editorial policy.
The educational health content on What To Expect is reviewed by our medical review board and team of experts to be up-to-date and in line with the latest evidence-based medical information and accepted health guidelines, including the medically reviewed What to Expect books by Heidi Murkoff. This educational content is not medical or diagnostic advice. Use of this site is subject to our terms of use and privacy policy. For breastfeeding infants, removing immunogenic foods e.
Changing the infant's body position while awake can be effective. The flat prone and left-side down positions are associated with fewer reflux episodes but should be recommended only in awake, observed infants during the postprandial period. Food and Drug Administration for gastroesophageal reflux treatment, but they have been implicated in several infant deaths and their use should have physician oversight.
Conservative treatments in older children and adolescents are largely extrapolated from adult studies. Interventions include dietary modification e. Sleeping with the head of the bed elevated or in the left lateral decubitus position may reduce reflux episodes.
For infants, children, and adolescents with GERD that does not improve with conservative treatment, an empiric four-week trial can be considered using acid suppression therapy with histamine H 2 receptor antagonists or proton pump inhibitors PPIs. H 2 antagonists decrease acid secretion by inhibiting H 2 receptors on gastric parietal cells. They improve clinical symptoms, decrease the reflux index, and improve histologic findings in infants, children, and adolescents; however, most studies have been of poor quality.
Low-quality evidence suggests that PPIs improve symptoms of GERD in infants; however, there is weak, conflicting evidence on whether they improve the reflux index, and no evidence of endoscopic improvement. Prokinetic agents have been proposed for GERD treatment, but their use is limited because of adverse effects or lack of consistent evidence.
Histamine H 2 receptor antagonists. Neonates: 5 to 10 mg per kg per day, divided every 8 to 12 hours. Affects cytochrome P, vitamin D metabolism, endocrine function.
Improves symptom scores, reflux index, and histologic and endoscopic findings in infants and children. Lacks evidence showing effectiveness in infants and children. Improves symptom scores in infants; improves reflux index and histologic and endoscopic findings in infants and children.
Infant to 16 years: 5 to 10 mg per kg per day, divided every 12 hours; maximum dosage of mg per day. Most commonly used H 2 receptor antagonist. No evidence for symptomatic improvement in infants, but has shown symptomatic benefit in children. Sprinkle contents of capsule onto food. Approved for up to 8 weeks of treatment. Sprinkle contents of capsule onto food or into juice; disintegrating tablet. Improves symptom scores, reflux index, and histologic and endoscopic findings in children.
Improves symptom scores and reflux index in infants and children. Lacks evidence of effectiveness in infants and children. Children: 0. Not recommended for routine treatment of GERD. Antacids magnesium or aluminum hydroxide. FDA approved for infants magnesium hydroxide only , children, and adolescents. Dosing not well established; in children, 40 to 80 mg per kg per day divided every 6 hours has been used. Constipation, dizziness, light-headedness. Generic price listed first; brand price listed in parentheses.
Information from references 4 , and 50 through If symptoms do not improve with acid suppression therapy, diagnostic testing is warranted to evaluate treatment failure, identify complications of GERD, establish a relationship between atypical symptoms and reflux, and exclude other diagnoses.
The advantages and limitations of various tests are summarized in eTable A. Acid suppression therapy as a diagnostic method A1. Four-week trial can be considered in older children and adolescents extrapolated from adult studies. Improvement after trial of therapy does not necessarily confirm GERD. Barium study A1 — A4. Can identify reflux regardless of pH.
Can reveal anatomic causes of GERD esophageal webs and strictures, tracheoesophageal fistula, esophageal and intestinal atresia, achalasia, pyloric stenosis, malrotation. Useful in assessing projectile or bilious vomiting, vomiting undigested food, or failure to thrive. Poor sensitivity and specificity for GERD. Endoscopy with biopsy A1 , A5 , A6. Direct visualization and histologic evaluation.
Can identify complications of GERD e. Cannot determine whether nonacidic reflux is occurring. Endoscopic and histologic esophageal findings in GERD are nonspecific and correlate poorly with symptom severity. Esophageal manometry A1. Can measure mechanisms of swallowing. Severity of acidic reflux does not correlate well with severity of symptoms, complications, or histology. Multiple intraluminal impedance combined with pH monitoring is considered superior to pH monitoring alone.
Multiple intraluminal impedance with pH monitoring A6 , A7. Determines frequency, duration, velocity, volume, and height of acidic, weakly acidic, and nonacidic reflux.
Unclear if it improves diagnostic accuracy or therapeutic decision making over pH monitoring alone. Nuclear scintigraphy A1 , A2. Questionnaires A2 , A5 , A6 , A8. Can quantify and track symptoms of GERD. Best validated questionnaire is the Infant Gastroesophageal Reflux Questionnaire-Revised; has high sensitivity but low specificity eTable B.
Diagnostic method of choice in evaluating for pyloric stenosis. Can detect fluid movements i. Not recommended for routine evaluation of GERD. J Pediatr Gastroenterol Nutr. Diagnostic accuracy of tests in pediatric gastroesophageal reflux disease. J Pediatr. Rosen R. Gastroesophageal reflux in infants: more than just a pHenomenon. JAMA Pediatr. ACR-SPR practice parameter for the performance of contrast esophagrams and upper gastrointestinal examinations in infants and children.
Resolution Amended Accessed July 8, A global, evidence-based consensus on the definition of gastroesophageal reflux disease in the pediatric population. Am J Gastroenterol. Gastroesophageal reflux: management guidance for the pediatrician. Orenstein SR. Curr Gastroenterol Rep. Upper endoscopy with biopsy is considered when reflux does not respond to initial treatments. It is the principal method of evaluating the esophageal mucosa for complications of GERD and excluding other possible causes, such as eosinophilic esophagitis, esophageal webs, and infectious esophagitis.
Esophageal pH monitoring is the most widely used test to quantify the frequency of reflux over 24 hours using the reflux index. Multiple intraluminal impedance plus pH monitoring is considered superior to pH monitoring alone because it can differentiate acidic, weakly acidic, or non-acidic reflux; identify solid, liquid, or gas reflux; and better determine the temporal correlation between reflux and atypical symptoms.
The high cost, high interobserver variability, and the lack of well-designed studies supporting its diagnostic accuracy limit its use. A barium study upper gastrointestinal series is useful for evaluating for anatomic causes of symptoms, particularly dysphagia and odynophagia, and bilious vomiting. It should not routinely be used to diagnose GERD or assess its severity.
Questionnaires may be used to quantify and track symptoms eTable B , and to assess treatment response, but they lack specificity in diagnosing gastroesophageal reflux or GERD. Has the baby ever stopped breathing while awake or struggled to breathe, or turned blue or purple? The infant gastroesophageal reflux questionnaire revised: development and validation as an evaluative instrument.
Clin Gastroenterol Hepatol. Surgical options are available and should be considered in children with complications from severe GERD if medical therapy is unsuccessful or is not tolerated. Surgical options include complete or partial Nissen fundoplication. Newer endoscopic approaches performed in adults have been studied in children.
Surgical treatments have significant risk of reflux recurrence and should be considered carefully. Data Sources: A PubMed search was conducted using the key terms reflux, gastroesophageal reflux, and gastroesophageal reflux disease, limited in children age 0 to 18, and combined in separate searches with epidemiology, etiology, pathophysiology, diagnosis, management, and treatment for reflux-related topics, including clinical reviews, randomized controlled trials, systematic reviews, and meta-analyses.
In addition, a search was conducted using individual diagnoses within the differential diagnosis of reflux as key terms, limited in children age 0 to 18, and combined in separate searches with etiology, diagnosis, management, and treatment. Relevant publications from the reference sections of cited articles were also reviewed. Search dates: January through July , and February and July The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of Defense, the U.
Army Medical Corps, or the U. Army at large. Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. At the time the article was submitted, he was the research director for the Family Medicine Residency Program at Carl R.
Darnall Army Medical Center. Address correspondence to Drew C. Reprints are not available from the authors. Vandenplas Y, et al. Gastro-oesophageal reflux disease: recognition, diagnosis and management in children and young people. Accessed July 17, Dent J.
Landmarks in the understanding and treatment of reflux disease. J Gastroenterol Hepatol. Garza JM, Kaul A. Gastroesophageal reflux, eosinophilic esophagitis, and foreign body. Pediatr Clin North Am. Salvatore S, et al. Gastroesophageal reflux disease in infants: how much is predictable with questionnaires, pH-metry, endoscopy and histology? Gastroesophageal reflux disease in children and adolescents in primary care. Scand J Gastroenterol. Common questions about outpatient care of premature infants.
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Clin Exp Gastroenterol. Martin AJ, et al. Natural history and familial relationships of infant spilling to 9 years of age. Nelson SP, et al. Prevalence of symptoms of gastroesophageal reflux during infancy. A pediatric practice-based survey. Arch Pediatr Adolesc Med. Campanozzi A, et al. Prevalence and natural history of gastroesophageal reflux: pediatric prospective survey. Prevalence of symptoms of gastroesophageal reflux during childhood: a pediatric practice-based survey.
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