Gastroesophageal Reflux (GER and GERD) in Infants and Children

  • Medical Author:
    John Mersch, MD, FAAP

    Dr. Mersch received his Bachelor of Arts degree from the University of California, San Diego, and prior to entering the University Of Southern California School Of Medicine, was a graduate student (attaining PhD candidate status) in Experimental Pathology at USC. He attended internship and residency at Children's Hospital Los Angeles.

  • Medical Editor: David Perlstein, MD, MBA, FAAP
    David Perlstein, MD, MBA, FAAP

    David Perlstein, MD, MBA, FAAP

    Dr. Perlstein received his Medical Degree from the University of Cincinnati and then completed his internship and residency in pediatrics at The New York Hospital, Cornell medical Center in New York City. After serving an additional year as Chief Pediatric Resident, he worked as a private practitioner and then was appointed Director of Ambulatory Pediatrics at St. Barnabas Hospital in the Bronx.

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What are the symptoms of GER and GERD in infants and children?

Infants with GER generally have no symptoms other than the obvious reflux of fluid out the mouth. As noted previously, they do not appear to have any discomfort associated with their reflux.

Infants and children with GERD may have multiple symptoms including:

How are GER and GERD in infants and children diagnosed?

The diagnosis of GER is based upon characteristic historical facts reported by the infant's parents coupled with an elimination of pathological conditions by a normal physical exam. It is very rare to need laboratory studies to establish or support the diagnosis.

The diagnosis of GERD is often accomplished by the pediatrician taking a thorough history supported by a complete physical examination enabling the elimination of other conditions that might cause similar symptoms. While rare, studies may be necessary to either establish/support the diagnosis of GERD or to determine the extent of damage caused by the repeated reflux events.

These studies may include:

  1. Barium swallow/upper GI series: This X-ray study involves drinking a material (barium) that allows visualization of the act of swallowing from mouth into the stomach by the propulsive motions of the esophagus and then emptying of the barium from the stomach into the upper part of the intestinal tract. This test is designed to confirm normal anatomy and function of the areas studies.
  2. pH probe studies: This test involves passage of a thin, flexible tube through the nose and into the lower regions of the esophagus. The goal is to document the frequency of reflux of stomach acid contents over a prolonged period (usually 24 hours).
  3. Endoscopy: Performed by a pediatric gastroenterologist, this procedure involves the passage of an endoscope (a thin, flexible tube with a light source and camera at the leading end) from the throat, through the esophagus and into the stomach to directly visualize damage caused by GERD as a result of stomach acid erosion.
  4. Gastric emptying study: This study involves drinking a mildly radioactive dye and monitoring the speed of passage from the stomach into the upper intestinal tract. Delay in emptying of stomach contents may predispose and aggravate GERD symptoms.
Medically Reviewed by a Doctor on 3/11/2016

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