Gastroesophageal Reflux Disease (GERD) in Children

What is GERD?

Gastroesophageal reflux (GER) occurs when gastric contents travel from the stomach into the esophagus. When this movement of fluid triggers symptoms that are bothersome, GER becomes gastroesophageal reflux disease (GERD).

If your baby is spitting up, they don’t necessarily need medication. In fact, they often outgrow this problem. What’s more, simple changes to the way you feed your baby could have a big effect on reflux. This animated video from Boston Children’s Hospital can provide answers for dealing with infant reflux.

What causes GERD in children?

The most common reason that gastric contents enter the esophagus in infants and children is because the lower esophageal sphincter (LES) relaxes, letting gastric fluid escape into the esophagus. This relaxation is normal, but can happen more frequently in some children. The diaphragm and stomach are also important in supporting the LES, so when one or both aren’t working properly, reflux may worsen. Finally, if your child’s esophagus doesn’t move normally, any reflux that enters the esophagus isn’t cleared well, putting children at risk for symptoms and esophageal damage.

Because GERD often gets blamed for a variety of symptoms, it’s important to see a clinician who is not only able to help to make an accurate diagnosis of GERD but who also considers other possible diagnoses to avoid unnecessary treatment.

What are the symptoms of GERD?

The symptoms of GER and GERD can vary from “spitting up” to severe difficulties with vomiting, esophageal inflammation, pain, and lung problems.

Each child may experience GERD differently. Common symptoms include:

  • heartburn
  • chest pain
  • bringing food up into the mouth
  • bad breath
  • stomachache or pain during or after eating
  • fussiness around mealtimes
  • hiccups
  • gagging or choking
  • frequent cough, coughing fits at night, or both
  • wheezing
  • vomiting
  • inability to gain weight
  • gastrointestinal bleeding

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 typically resolve on its own with time.

However, GERD may merit treatment when your child has:

  • frequent vomiting that results in poor weight gain and growth
  • pain that interferes with daily functioning
  • complications of reflux such as inflammation (esophagitis), ulcers (sores) that form in the esophagus, or respiratory problems that result in hospitalization

How we care for GERD in children

At Boston Children’s Hospital, we treat the most difficult cases of GERD. Our team will get to the root of your child’s reflux using sophisticated tests and a team approach to care. These tests can also help rule out GERD, preventing misdiagnosis and providing second opinions when necessary. The team of clinicians in our Aerodigestive Center also specializes in the evaluation and treatment of children with intractable GERD who have undergone previous surgical procedures to control the reflux (fundoplication) and continue to have problems after surgery.