Foods That Trigger Heartburn
Some of the foods that may contribute to heartburn in infants and children include:
- Too much food
- Fatty foods
- Spicy foods
Some of the foods that may contribute to heartburn in infants and children include:
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, and in infants, through the nostrils.
Gastroesophogeal reflux is different from vomiting because usually it is 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 (gastroesophageal 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 gastroesophogeal reflux. 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."
GERD implies a much different condition. Infants and children with GERD often experience distress because of their reflux even if the refluxed stomach contents are not completely ejected from the mouth. Infants and young children may lose 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.
Infants with GER generally have no symptoms other than the obvious reflux of fluid out the mouth. As mentioned previously, they do not appear to have any discomfort associated with their reflux.
Infants and children with GERD may have multiple symptoms including:
Infants with gastroesophogeal reflux reflect the immaturity their nervous system. In most infants the junction between the esophagus and stomach is "closed," opening only to allow passage of formula or breast milk into the stomach or to allow the escape of swallowed air via burping.
During episodes of reflux, this junction is continuously open allowing a backwards flow of stomach contents into the esophagus. This reverse flow may occur as a consequence of a relatively large volume of fluid relative to a smaller stomach volume, pressure on the abdominal cavity (for example, placed face down [prone] following a feeding), or overfeeding. Infant GER occurs in over 50% of healthy infants with a peak incidence (65%) at approximately 4 months of age. Most episodes resolve by 12 months of age. GER may occur in both breastfed and/or formula fed infants. Several studies document that breast fed infants empty their stomach faster than formula fed infants and are thus less likely to experience GER symptoms.
Gastroesophogeal reflux disease also reflects a relaxation of the esophageal-stomach junction similar to infant GER. Factors that may contribute to GERD in infants and children include:
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. Part of the evaluation of an infant who may have GER is to rule out pyloric stenosis. Pyloric stenosis is the thickening of the region of the stomach (pyloris) as it transitions into the first section of the small intestine. Studies show that most infants with pyloric stenosis have recurrent symptoms of forceful emesis shortly after a meal. The child is generally content until just before vomiting. There is a genetic predisposition favoring the first-born male. Diagnostic evaluation includes abdominal ultrasound or barium swallow (see below). A surgical procedure provides a cure of the condition.
Pediatricians diagnosis GERD in infants and children by 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 either to establish/support the diagnosis of GERD or to determine the extent of damage caused by the repeated reflux events.
These studies may include:
Rarely, an infant with GER generates 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:
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:
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.
Since the fundamental issue for infants with GER is "tincture of time," most infants need no specific therapy. Lifestyle adjustments that have been helpful for some infants include:
Rarely, 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.
The prognosis for infants with GER is excellent. The majority of infants will have resolved their symptoms by 9 to 12 months of age. Infants who required medications during the first few months of life generally "outgrow" their medication during the end of the first year of life.
Children who experience GERD symptoms also have a favorable prognosis though it may require longer use of medications and utilization of life style changes for many months. It is important to note that classic "heartburn" symptoms may resolve, but more subtle evidence of reflux (for example, persisting cough, especially when laying face up [supine]) may develop. Your child's pediatrician is a valuable asset to help monitor for these less obvious presentations of GERD.
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Endoscopy is a broad term used to described examining the inside of the body using an lighted, flexible instrument called an endoscope. Endoscopy procedure is performed on a patient to examine the esophagus, stomach, and duodenum; and look for causes of symptoms such as abdominal pain, nausea, vomiting, difficulty swallowing, or intestinal bleeding.
Anal itching is the irritation of the skin at the exit of the rectum, known as the anus, accompanied by the desire to scratch. Causes include everything from irritating foods we eat, to certain diseases, and infections. Treatment options include medicine including, local anesthetics, for example, lidocaine (Xylocaine), pramoxine (Fleet Pain-Relief), and benzocaine (Lanacane Maximum Strength), vasoconstrictors, for example, phenylephrine 0.25% (Medicone Suppository, Preparation H, Rectocaine), protectants, for example, glycerin, kaolin, lanolin, mineral oil (Balneol), astringents, for example, witch hazel and calamine, antiseptics, for example, boric acid and phenol, aeratolytics, for example, resorcinol, analgesics, for example, camphor and juniper tar, and
Gas (intestinal gas) means different things to different people. Everyone has gas and eliminates it by belching, burping, or farting (flatulence). Bloating or abdominal distension is a subjective feeling that the stomach is larger or fuller than normal. Belching or burping occurs when gas is expelled from the stomach out through the mouth. Flatulence or farting occurs when intestinal gas is passed from the anus.
Causes of belching or burping include drinking too rapidly, anxiety, carbonated drinks, habit, and swallowing air.
Causes of bloating or distension include tumors, ascites, fluid within the gastrointestinal (GI) tract, and obesity.
Causes of gas or flatulence are diseases such as sugary foods and drinks, fruits and vegetables, starches (wheat, oats, corn, and potatoes), lactose intolerance, untreated celiac disease, and SIBO.
Treatment for excessive intestinal gas depends on the cause. If anal itching persists, a doctor examination may be needed to identify an underlying cause.
Reflux laryngitis is caused by acid refluxing back up through the esophagus and voice box. Reflux laryngitis causes irritation and inflammation of the lining of the esophagus, larynx, and throat; and can lead to symptoms, signs, and other problems like esophagitis, sinusitis, strictures, throat clearing, swallowing problems, asthma, chronic cough, and growths on the vocal cords. Typical symptoms of reflux laryngitis include heartburn, hoarseness, or a sensation of a foreign body in the throat.
Reflux laryngitis can be treated with diet chanes, OTC medication, prescription medication, and lifestyle changes.