Definition:

Gastroesophageal reflux (GER) is a common pediatric concern. It occurs when stomach contents move up the esophagus, which can result in "spitting up". Most, if not all, babies have some degree of GER or spitting, but only occasionally is therapy indicated. GER typically begins in the first month of life. Most kids outgrow reflux by 8-9 months of age.

Babies who frequently spit up, but are growing well, are happy, and have no breathing difficulty, do not require any therapy. However, you should be prepared with a cloth diaper or bib, extra outfits, a delay in getting the carpets cleaned, and the expectation of doing a fair amount of laundry.

Most babies who spit up continue to gain weight well. Studies have found that caregivers consistently over estimate the amount of spit up. Some babies, however, do need therapy.

Reasons for treating children with GER include:

• Poor weight gain.
• Fussiness due to esophageal irritation from the acidic stomach contents. These children tend to be extremely fussy, especially during feedings and they often pull away from the bottle or breast.
• Respiratory difficulties. Children can develop chronic coughs and wheezing due to aspiration of stomach contents and spasms of the airway. Coughing during and immediately after feedings should alert you to a possible problem.

How to diagnosis GER:

The diagnosis of GER is often made based on the history alone. Occasionally an ‘upper GI’ x-ray is performed. This involves having an x-ray taken after ingestion of a radio-opaque dye. Also a ph probe test can be used to demonstrate acidic stomach contents entering the esophagus.

Treatment:

Often the following may help GER:

• Elevate the infant’s head (or keep in an upright position) for 30 minutes after feeding.
• Thicken formula with rice cereal. Ask your practitioner for details.
• Smaller, more frequent feeds (though you should wait at least 2 hours between meals in order to allow the stomach to empty.
• Burp your child 2-3 times during each feed.

Sometimes your practitioner may recommend one of the following medications:

• Antacids, like Mylanta, Tagamet, and Zantac, are used to control the acid pH of the refluxed material. This will reduce the burning and pain, thus, reducing fussiness and improving your child's ability to eat.
• Gastric motility medication like Reglan are used to decrease the excess spitting.

Prognosis:

The majority of children outgrow this condition within the first year, often within a few months.

CALL THE OFFICE if:

• Your child demonstrates symptoms of GER
• Your child is not responding to therapy
• Your child has developed worsened or recurrent symptoms
• Your child is having breathing difficulties
• You have other concerns or questions