Gastroesophageal Reflux (GER) in Children

  • What is 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.

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