Our Health Topics

Gastroesophageal Reflux (GER)

  • Gastroesophageal reflux (GER), also called acid reflux or heartburn, occurs when stomach contents (acidic stomach juices, foods or fluids) return from the stomach into the esophagus (the tube between the mouth and the stomach). Reflux is very common in infants; it is the most common cause of vomiting or “spitting up” during infancy. In most babies, the problem will get better on its own. However, in some cases, reflux may require attention from a clinician.

    Typically, GERD (gastroesophageal reflux disease) happens when there is a problem with the lower esophageal sphincter (LES), the muscle that opens to let food enter into the stomach and then closes to keep it there. If this muscle relaxes too often or for too long, stomach contents flow back up into the esophagus, causing vomiting or discomfort (“heartburn”).

    Infants with GER can have varied symptoms but common symptoms include:

    • frequent vomiting or “spitting up
    • refusal to eat
    • discomfort and/or fussiness during or after feedings
    • problems sleeping
    • a lot of crying
    • hiccups
    • gagging or choking
    • breathing problems, such as wheezing or coughing fits, at night

    Some infants with GER may have stomach contents move up the esophagus and spill over into the windpipe. This can cause discomfort and lead to problems such as asthma, pneumonia or trouble breathing.

    How Boston Children's approaches gastroesophageal reflux (GER):

    Initially, you will meet with a specialist from Boston Children's Hospital's Division of Gastroenterology, Hepatology and Nutrition  who may recommend trying different ways of positioning and feeding your infant. Some infants may need medicine. If your infant has frequent “spit ups” but appears comfortable and is growing well, no treatment may be needed.

    A few ways to avoid or reduce GER for a baby include:

    • If bottle feeding, provide smaller, more frequent feeds. Over-feeding (giving more formula/breast milk than the stomach can hold) can cause an increase in reflux. (Your provider can help you figure out the right daily amount of formula your child needs.) Hold your baby semi-upright during feedings (not flat). Keep the bottle nipple filled with formula/milk, so your child doesn’t swallow too much air.
    • Do not prop your infant’s bottle, as it may cause your baby to choke or take formula into their lungs.
    • Do not add cereal or other thickeners into the bottle unless your provider tells you to.
    • Burp your baby many times during feedings.
    • After feedings, hold your child upright for at least 30 minutes. Try to keep your baby quiet and relaxed after feedings.
    • For sleep, you may place rolled towels under the mattress to raise the head of the crib 30°. Do not use pillows or other soft sleep positioners in the crib.

    Your physician also may give advice about diet and lifestyle changes that can help manage symptoms, such as:

    • offering your child smaller portions at mealtimes and encouraging your child not to overeat
    • serving dinner at least two hours before bedtime

    For more information on GER or to speak with a member of Boston Children's Division of Gastroenterology, Hepatology and Nutrition, please call 617-355-6058.

    Division of Gastroenterology, Hepatology and Nutrition

    Locations

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    Contact

    Boston

    Boston Children's Hospital
    300 Longwood Avenue
    Boston, MA 02115
    Fegan-5

    617-355-6058

    Click here for information about our other locations throughout the Boston area.

     


  • What causes gastroesophageal reflux (GER)?

    The lower esophageal sphincter, or LES, is a muscle located at the bottom of the esophagus; it opens to allow food entry into the stomach and then closes to keep it there. If this muscle relaxes too often or for too long, acid refluxes back into the esophagus, causing vomiting or heartburn. When this happens many times, this is called GERD (gastroesophageal reflux disease).

    What is heartburn?

    Heartburn, or acid indigestion, is a burning chest pain that begins in the breastbone and moves upward to the neck and throat. It can last as long as two hours, and is often worse after eating.

    Are there other symptoms of GER?

    Each child experiences symptoms differently, but common symptoms include:

    • Belching
    • Stomachache
    • Refusal to eat
    • Frequent vomiting
    • Hiccups
    • Gagging
    • Choking
    • Coughing fits at night
    • Wheezing
    • Frequent colds
    • Frequent sore throats, especially in the morning
    • A sour taste in the mouth

    What are the complications associated with GER?

    Some infants and children with this condition may have stomach contents move up the esophagus and spill over into the windpipe. This can cause:

    Other dangers include:

    • Failure to grow and gain weight, if your child vomits frequently.

    • Anemia, caused by inflammation or ulcers in the esophagus.

    • Possible long-term complications like esophageal narrowing and Barrett's esophagus, abnormal cells in the esophageal lining.

    Are there foods that cause or worsen GER?

    Chocolate, peppermint, and many high-fat foods seem to cause the LES to stay open longer than normal; citrus fruits and tomatoes increase acid production in the stomach. Your child should also avoid caffeinated drinks, such as soda.

  • Your child's physician will perform a physical examination and obtain a medical history. Diagnostic procedures that may be done include:

    • A chest x-ray, to look for evidence of aspiration or pneumonia

    • An upper gastrointestinal series, which examines the organs of the upper part of the digestive system; your child will swallow a fluid called barium-a chalky liquid used to coat the insides of the esophagus, stomach, and the first section of the small intestine so that they can be seen in an x-ray.

    • An endoscopy, a test that uses a small, flexible tube with a light and a camera at the end to examine the inside of the digestive tract.

    • PH Testing, in which a small tube is passed into the esophagus to measure the pH, or acid level therein, over 12 to 24 hours

  • Treatments vary based on your child's age, health, and medical history, the extent of your child's disease, his tolerance for specific medications, procedures, and therapies, and, of course, your own opinions and preferences. Standard treatments include:

    • Medications such as Zantac, Prilosec, and Prevacid may be taken daily to decrease the amount of acid in the stomach, which, in turn, will cut down on the heartburn associated with reflux.

    • Your child's physician may also prescribe a medication, called Raglan, to be taken before meals and at bedtime which helps the stomach to empty faster.

    • If your child is unable to gain weight due to frequent vomiting, your child's physician may recommend adding rice cereal to baby formula, adding a prescribed caloric supplement to breast milk or baby formula, or, if an allergy is suspected, your physician may advise you to switch to a soy-free formula.

    • Tube feedings may be recommended for babies suffering from other conditions (such as congenital heart disease or prematurity) in addition to reflux.

    • a surgical procedure called fundoplication may be performed.

    Your physician can also advise about diet and lifestyle changes that may help manage symptoms, such as:

    • Offering your child smaller portions at mealtimes, and encouraging your child not to overeat.
    • Serving dinner at least two hours before bedtime

    For infants:

    • When using a bottle, keep the nipple filled with milk so that your child doesn't swallow too much air.

    • Burp your baby several times during feedings.

    • After feedings, hold your child upright on your lap for thirty minutes.

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