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.

What is the treatment for GER in infants?

Since the fundamental issue for infants with GER is "tincture of time," most infants need no specific therapy. Lifestyle adjustments which have been helpful for some infants include:

  • Mild elevation of the head of the crib mattress
  • Maintaining an upright position for the first 20 to 30 minutes following a feeding
  • Thickening of the formula with rice cereal
  • Utilization of an "elemental" formula (for example, Alimentum)
  • Introduction of solid foods at the safe and appropriate age (please check with your child's pediatrician prior to initiating these processes).

It is rare, however, an infant may require medications to bridge the gap during the neurologic maturation process that enables your child to "outgrow" his or her GER. These medications are discussed later.

How are GER and GERD treated in infants and children?

It is rare for an infant with GER to generate substantial discomfort, demonstrate aversion to feeding, or show suboptimal weight gain. Conversely, toddlers and older children may experience more substantial symptoms, and thus may need a trial of lifestyle modifications including:

  • mild elevation of the head of bed,
  • serving smaller but more frequent meals,
  • monitoring your child's diet to determine whether specific foods or drinks may tend to aggravate his or her symptoms, and
  • weight reduction if indicated.

There are several groups of medications that may need to be considered in certain cases of infant GER (rare) or toddler/childhood GERD. These include:

  1. Medication to lessen gas, for example, Mylicon or Gaviscon
  2. Medication to neutralize stomach acid, for example, Mylanta or Maalox
  3. Medication to lessen stomach acid histamine blockers, for example, ranitidine (Zantac), famotidine (Pepcid) or cimetidine (Tagamet), and proton pump inhibitors or PPIs, for example, omeprazole (Prilosec), lansoprazole (Prevacid) or rabeprazole (Aciphex)
  4. Medication to promote emptying of stomach contents, for example, metoclopramide (Reglan, however, it has a number of side effects) or erythromycin (more routinely used as an antibiotic but known to have side the effect of increasing stomach contractions, but may be helpful with GERD)

The use of these medications follows a stepwise approach (from #1 to #4) based upon severity of symptoms. Consultation with a pediatric gastroenterologist may be helpful for patients whose response to the above approach is disappointing.

There are very cases where children whose GERD is so severe that a surgical procedure must be considered to manage symptoms. The procedure, called a Nissen fundoplication, involves wrapping the top part of the stomach around the lower esophagus. The displaced stomach contracts during the digestive process, and thus closes off the lower esophagus and prevents reflux. In extraordinary circumstances, a feeding tube directly into the stomach is necessary to complement the Nissen fundoplication.

Medically Reviewed by a Doctor on 3/11/2016

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