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What are GER and GERD in infants and children?
Gastroesophogeal reflux (GER) is the upward flow of stomach contents from the
stomach into the esophagus ("swallowing tube"). While not required by its
definition, these contents may continue from the esophagus into the pharynx
(throat) and may be expelled from the mouth. GER differs from vomiting
in that it is generally not associated with a violent ejection. Moreover, GER is
generally a singular event in time whereas the vomiting process is commonly
several back-to-back events that may ultimately completely empty all stomach
contents and yet still persist ("dry heaves"). The difference
between GER and GERD (gastroesophogeal reflux disease) is a matter of severity
and associated consequences to the patient.
The large majority of healthy, full term infants will have episodes of
"spitting up" or "wet burps," which technically qualify to be considered GER.
These infants generally do not seem in distress before, during, or after by the
reflux process. Likewise, the loss of calories as an outcome of GER is
inconsequential since growth parameters including weight gain are not affected.
Lastly, there seem to be no short or long term consequences of these reflux
experiences. In short, infants with GER are "messy spitters."
The very name of GERD ("disease") implies a much different condition.
Infants and children with GERD often experience distress as a consequence of
their reflux even if the refluxed stomach contents are not completely ejected
from the mouth. Infants and young children may loose so many calories by
expulsion that growth is compromised. Some infants or children with GERD
may even become averse to feeding due to repeated associations with feeding and
pain. Finally, there are a number of short and long term consequences of
GERD that are not associated with infants and children with GER. These
will be discussed further in this article.