GASTROESOPHAGEAL REFLUX DISEASE
Gastroesophageal reflux disease (GERD) in children is a condition in which stomach contents flow back into the esophagus, causing symptoms ranging from mild discomfort to more significant issues. In infants, GERD can manifest as frequent spitting up or vomiting, irritability during or after feedings, refusal to eat and at its worst poor growth and malnutrition. However, it’s important to distinguish GERD from simple gastroesophageal reflux (GER), which is quite common in infants and often referred to as “happy spitting.” In these cases, infants spit up regularly but remain healthy and content, showing no signs of abdominal pain, discomfort or poor growth. For these “happy spitters,” no treatment is typically necessary, as they often outgrow the condition by 12 to 18 months of age.
The first line of treatment for the more severe gastroesophageal reflux disease (GERD) in infants often involves dietary changes, particularly aimed at eliminating cow’s milk protein, which can be a common trigger for vomiting. For breastfed infants, this means that the nursing mother may need to modify her diet by avoiding all dairy products to see if the infant’s symptoms improve (Ouch! That means no pizza for the mother).
For formula-fed babies, switching to a hypoallergenic or elemental formula, like Nutramigen, can be beneficial. Nutramigen is a hydrolysate formula in which milk proteins are partially broken down to reduce allergic reactions. These formulas reduce milk protein allergens that might worsen the vomiting. In more severe cases, switching to an amino acid-based formula, such as PurAmino, may be recommended. These formulas are even more hypoallergenic, containing amino acids, the building blocks of protein. Such dietary changes can significantly reduce vomiting and improve the infant’s comfort, potentially decreasing the need for medication.
Medication for GERD is reserved for children with significant feeding issues, poor weight gain, or GERD-related irritability. Common medications include H2 blockers like famotidine and proton pump inhibitors (PPIs) like omeprazole, which reduce stomach acid production to alleviate symptoms and allow the esophagus to heal. It's essential to use these medications only under our guidance due to potential side effects.
Parents should seek medical attention if their child exhibits alarming symptoms such as projectile vomiting, blood in the vomit, difficulty breathing, or chronic respiratory issues like wheezing or coughing. These symptoms may indicate conditions other than GERD and require further evaluation. This evaluation may include tests such as an ultrasound of the pylorus and abdomen, an upper gastrointestinal (UGI) series of X-rays, esophageal pH monitoring, chest X-ray, or an endoscopy to assess the esophagus and stomach thoroughly. Some of those tests require pediatric gastroenterology referral.
In some children, GERD symptoms overlap with eosinophilic esophagitis (EoE), an allergic condition that causes a buildup of eosinophils, a type of white blood cell, in the esophagus. This buildup leads to inflammation and damage of the esophagus and presents with symptoms similar to GERD, such as difficulty swallowing, food impaction, and chest pain. Diagnosing EoE requires an endoscopy with biopsies to detect eosinophils in the esophageal lining. Treatment often involves dietary changes to eliminate allergens, typically in collaboration with a nutritionist, and medications like topical corticosteroids to reduce inflammation. Cow's milk allergy or intolerance is one such example.
GERD Summary: With proper management and occasional medical intervention, children with gastrointestinal reflux issues can achieve comfort and thrive. Parents with children with GERD should seek treatment during a regular office visit to develop a treatment plan. Ongoing monitoring and treatment adjustments are necessary over time.
