Gastroesophageal Reflux Disease (GERD) in Children

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Gastroesophageal reflux (GER) is a digestive disorder that returns acidic or non-acid stomach juices, food or fluids back up into the esophagus. It is also called acid reflux or heartburn. When the GER becomes an illness, it is called gastroesophageal reflux disease (GERD).

The symptoms of GER and GERD can vary from “spitting up” to severe difficulties with vomiting, esophageal inflammation, pain and lung problems. At Boston Children’s GI Motility Center, we treat the most difficult cases of GER and GERD.

Boston Children’s pediatric gastroenterology department ranks no. 1, according to U.S.News & World Report. Our team will get to the root of your child’s reflux using sophisticated tests and a team approach to care. Meet our GI Motility team.

Symptoms of GERD

Each child may experience symptoms of GERD differently. Symptoms may include:

  • Belching
  • Refusal to eat
  • Stomachache or pain when eating
  • Fussiness around mealtimes
  • Hiccups
  • Gagging or choking
  • Frequent cough and/or coughing fits at night
  • Wheezing
  • Frequent ear infections
  • Rattling in the chest
  • Vomiting
  • Heartburn
  • Inability to gain weight
  • GI bleeding

Is GERD Serious?

Spitting up is a normal occurrence for young infants. As long as your child is growing well and not developing other problems, such as breathing difficulties, the condition needs no treatment and will resolve on its own with time.

However, GERD is considered serious when:

  • Babies vomit frequently, resulting in poor weight gain and growth.
  • Inflammation (esophagitis) or ulcers (sores) form in the esophagus due to contact with stomach acid.
  • The ulcers become painful and also may bleed, leading to anemia (too few red blood cells in the bloodstream).
  • It has associated respiratory problems.

Advanced GERD Testing at Boston Children's

The underlying cause of your child’s discomfort may be related to other conditions, such as digestive disorders or pulmonary (lung) problems. We use a comprehensive, holistic approach to diagnosing and treating GERD, often collaborating with experts across multiple specialties.

Our GI Motility Center also specializes in the evaluation and treatment of children with GERD that have undergone previous surgical procedures to control the reflux (fundoplication) and continue to have problems after surgery.

We may recommend one or more of these procedures in order to properly diagnose your child’s condition:

  • High-resolution esophageal manometry: We place a thin tube through the nose or mouth into the esophagus to measure the pressure within the esophagus and the lower esophageal sphincter.
  • Endoscopy: This procedure involves the use of a thin and lighted tube placed through the nose or mouth into the esophagus to "see" inside the esophagus.
  • pH impedance testing: An impedance study (with pH monitoring) evaluates acid and non-gastroesophageal reflux to determine if contents from the stomach are leaking into the esophagus (food tube) and are associated with symptoms.
  • BRAVO® placement: During this test, we attach a wireless capsule to the esophagus to record what the acid does inside the body.
  • Upper GI endoscopy: A flexible tube is placed from the mouth into the stomach. This allows visualization and sampling (biopsies) of the different organs to see if there is underlying inflammation or a reason for the GERD symptoms.
  • Upper GI (gastrointestinal) series: This test examines the organs of the upper part of the digestive system using barium, a radio-opaque liquid that coats the inside of organs so that they will show up on an X-ray.
  • Gastric emptying studies: These tests determine whether or not the stomach contents empty into the small intestine properly. Delayed gastric emptying can contribute to GERD, allowing stomach contents to back up into the esophagus.

Read more about GI motility testing at Boston Children’s.

GERD Treatment at Boston Children's

GERD treatment varies with age. At Boston Children’s, our first step in treating normal reflux in infants is to look for solutions that do not require the use of medication. On your first visit, you will meet with a gastroenterology specialist who may recommend trying different ways of positioning and feeding your infant.

Many babies with GER will outgrow it by the time they are about one year old, as the lower esophageal sphincter becomes stronger. For others, medications that take away the stomach acid, or make the stomach empty faster, can minimize reflux, vomiting and heartburn. Lifestyle and dietary changes may also help.

For more severe cases, the GI Motility Center provides advanced therapies not routinely available. We may recommend surgery to reinforce the lower esophageal sphincter and mechanically discourage reflux.

For patients with GERD that have undergone surgery and continue to have problems, we offer a series of specialized treatments that include medications to relax the stomach, such as injections of Botox or medications to improve gastric emptying and help reduce pain.

Depending on the impact that the reflux or its treatment has had on other organs, you may meet with specialists from our Aerodigestive Program. We will work to make these appointments as convenient as possible for you and your child.

Learn more about our GI motility treatments and approach at Boston Children’s.

Make an Appointment

For an appointment, more information or to obtain a second opinion for your child, please contact the Motility and Functional Gastrointestinal Disorders Center at 617-355-6055 or request an appointment online.

Boston Children’s is so much more than a hospital—it’s a community of researchers, clinicians, administrators, support staff, innovators, teachers, patients and families, all working together to make the impossible possible. ”
- Sandra L. Fenwick, President and CEO

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