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Acid Reflux
Acid Reflux In Children: Symptoms, Causes & Treatment
Jul 20, 2017Does your child complain of pain and uneasiness after eating? If your child doesn’t like to eat, complains of pain afterwards, is a highly fussy eater and has a persistent sore throat or cough, chances are that he or she suffers from acid reflux.
Acid Reflux can often be difficult to diagnose in children, especially those who are under 12 years of age. Tests to confirm GERD are highly invasive and often not recommended for infants and young kids. Since proper diagnosis can be difficult and refusal to eat may be rather tricky to differentiate from mild indigestion or flu in young kids, parents can have a hard time coming up with the right treatment plan for acid reflux in children.
Understanding Acid Reflux In Children
Acid Reflux occurs when stomach acid flows back up the esophagus and spills into the throat, causing a burning sensation, pain, nausea and other symptoms. The LES or Lower Esophageal Sphincter is a muscular valve that allows food from the esophagus into the stomach but shuts tightly after swallowing to stop stomach acid and other contents to come back up. When the LES doesn’t function properly and doesn’t close completely, acid can travel back into the esophagus, causing acid reflux or GERD.
Serious acid reflux is less common in infants who are more likely to spit up milk/formula due to immaturity of lower esophageal sphincter function which manifests by frequent transient lower esophageal relaxations. Regular feedings in infants buffers reflux and usually doesn’t require any medical treatment. As the baby grows and the digestive system develops, spitting up resolves naturally.
Children over the age of 2 years old may be diagnosed with acid reflux if they are showing other complications of reflux like poor growth pattern, chronic cough and sore throat, esophagitis, poor appetite, pain after eating, tooth erosion and inflammation of the esophagus.
Symptoms Of Acid Reflux In Children
Symptoms of acid reflux in children will vary depending on their age. Infants with reflux typically spit up food often and show signs of decreased appetite, sleep disturbance and irritability. However, GERD or serious acid reflux is highly unlikely in an otherwise healthy and thriving infant.
The most commonly seen symptom of acid reflux in children over 12 years of age as well as older teens is heartburn – a burning sensation felt behind the breastbone and/or middle of abdomen. In most cases, children who are under 12 years of age don’t typically complain of heartburn. In older children and adolescents, some other acid reflux symptoms include:
- Discomfort when swallowing
- Frequent cough or wheeze
- Hoarseness
- Excessive belching
- Frequent nausea
- Taste of stomach acid in the throat
- Pain when lying down after eating
- Feeling of food stuck in the throat
In young children and preschoolers, symptoms of acid reflux can be:
- Poor appetite (some parents notice their child prefers liquids to solid food)
- Regurgitation
- Weight Loss
- Nausea
- Vomiting
- Bad Breath
- Pain during Swallowing
- Tooth Erosion, caused by acid backing up into the mouth
- Chronic Cough or Sore Throat
- Respiratory Problems like Wheezing or recurrent Pneumonia
Causes Of Acid Reflux In Kids
Causes of Acid reflux in children
Most of us associate GERD with adults over the age of 40, caused by a variety of poor lifestyle choices and diet. But what causes acid reflux in children?
Doctors aren’t always sure of why acid reflux affects children, but sometimes the angle at which the stomach and esophagus meet, or pinching of the fibers of the diaphragm can be the cause. Some children have a weak LES by birth, which makes them particularly predisposition to reflux. Acid Reflux has a genetic influence in some families.
Studies have found prevalence of symptoms associated with acid reflux was increased in children with asthma as well as in overweight children. Being overweight and asthma are both independently associated with GERD symptoms.
Increasing childhood obesity is a serious concern. With some many children being obese, more and more doctors in clinical practice find that their reflux patients are overweight children. Results from the Children’s Health Study, published in the Journal of Pediatrics in March 2010, reported that 7.3% of boys and 5.5% of girls aged 2 to 19 years are now classified as extremely obese. In older children and in teens, extreme obesity is associated with up to a 40% increase in GERD risk and moderate obesity is associated with up to a 30% increase in risk. According to research data, this poses serious implications for their future risk of GERD-associated diseases, such as esophageal adenocarcinoma.
Researchers estimate that gastroesophageal reflux may be present in 40% to 80% of children with asthma. And while asthma and acid reflux can occur together in children, some asthma medication like theophylline can worsen reflux. Other studies have found the prevalence of Reflux Esophagitis is significantly higher in overweight children, especially those already on anti-reflux medications
Acid Reflux can also be caused by other medications your child may be on, such as painkillers which increase acidity in the stomach and antibiotics such as tetracycline which can directly irritate the esophagus. Second hand tobacco smoke can also increase risk of acid reflux.
Acid Reflux is also seen in children who have had previous esophageal surgery and those with neurological conditions like cerebral palsy.
Reflux Medication Is Not Always The Answer
Acid reflux in children
When it comes to using reflux medication in children to suppress gastric acid production, extreme caution must be used. Studies find that PPIs or Proton Pump Inhibitors (which are rather commonly prescribed by most pediatricians) are not effective in reducing GERD symptoms in infants. Placebo-controlled trials in older children are lacking. Although PPIs seem to be well tolerated during short-term use, evidence supporting the safety of PPIs is lacking. Also, PPIs can rob the body of essential nutrients; these drugs do not treat the condition at its root and only provide relief from immediate symptoms.
Some doctors can prescribe PPIs for children who have both asthma and GERD in the hope that suppressing gastric acid will show improvements in symptoms of both diseases, but this couldn’t be further away from the truth. In fact, a study done in Norway found that treatment with common PPIs to suppress acid production did not improve asthma symptoms or lung function in children with asthma and GERD.
Long-term use of acid medications can cause serious side-effects, like:
- Lead to iron, zinc, calcium, vitamin B12 and magnesium deficiency
- Increased risk of acute gastroenteritis and community-acquired pneumonia in children
- Increase risk of chronic kidney disease
- Increase chances of fungal infections in the gut
- Increase risk of enteric infections
- Increase risk of fractures
- Alter the bacterial flora of the upper gastrointestinal tract
- Reduce healthy gut bacteria while increasing bad, disease causing bacteria in the gut
- Lead to Clostridia difficile infections, which is a hard-to-treat bacteria causing diarhea
- Cause bacterial infections of the small intestines
Caring For Kids With Acid Reflux
Acid Reflux can be particularly distressing for young children and can encourage an unhealthy relationship with food. After all, why will your child enjoy eating food if it’s followed by pain? And while it’s best to limit treatment with reflux medication to 2 weeks, some lifestyle and diet changes can go a long way towards a healthy, happy, active life despite the acid reflux.
- Depending on your child’s routine, plan for smaller but more frequent meals. Eating smaller portions makes it easier for the stomach to digest the food while overeating will only exert extra pressure on the stomach.
- Remind your child to not to lie down within two hours of eating.
- If your child is overweight, encourage him/her to lose weight by enrolling in sports and activity classes, and cooking with more wholesome, nutritious foods.
- Avoid spicy foods, high-fat foods, and acidic fruits and vegetables, which can irritate the stomach. Both sodas and fruit juices are best avoided.
- Other foods to avoid are chocolates, mints, fast food, garlic, and sometimes cruciferous vegetables. You may need a trial and error method to identify your child’s acid reflux food triggers, but it’s so worth the effort. Avoiding food triggers is one of the easiest ways to cope with acid reflux disease.
- Discourage physical exertion or playing sports immediately after eating, as that can loosen the LES allowing stomach acid and partly digested food to come back up the esophagus.
- Elevate the head during sleep so that gravity can keep stomach acid and other contents where they belong.
- Avoid tight fitting clothes. Also let your child know that wearing tight belts (including a tight seat belt in the car) and bending over after eating can worsen reflux symptoms.
- No child should be around cigarette smoke, especially one with GERD.
- Add probiotics to your child’s diet to promote healthy gut bacteria.
It may take a little time for these lifestyle changes to show positive improvements in your child’s acid reflux symptoms. However, if symptoms do persist, talk to your pediatrician about other treatment options available to you. Some supplements can also be useful in coping with severe GERD symptoms.
Maneera is a health and fitness enthusiast who is also a firm believer in the power of dietary supplements. A health buff, she likes to help others improve their overall well-being by achieving the right balance between nutrition, exercise and mindfulness.
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References:
Prevalence of Symptoms of Gastroesophageal Reflux During Childhood: A Pediatric Practice-Based Survey – https://jamanetwork.com/journals/jamapediatrics/fullarticle/348635
Asthma and overweight are associated with symptoms of gastro-oesophageal reflux – https://www.ncbi.nlm.nih.gov/pubmed/16982489?dopt=AbstractPlus
Gastroesophageal reflux and asthma in children: a systematic review – https://www.ncbi.nlm.nih.gov/pubmed/20351005/
The Association between Childhood Overweight and Reflux Esophagitis – https://www.hindawi.com/journals/jobe/2010/136909/
Acid suppression does not change respiratory symptoms in children with asthma and gastro-oesophageal reflux disease – https://adc.bmj.com/content/90/9/956
Gastroesophageal reflux association with laryngomalacia: a prospective study – https://www.sciencedirect.com/science/article/pii/S0165587697001511
Extreme childhood obesity is associated with increased risk for gastroesophageal reflux disease in a large population-based study – https://www.ncbi.nlm.nih.gov/pubmed/20615162
Obesity in Children Associated With Increased Risk for GERD – https://www.medscape.org/viewarticle/725102
Efficacy of Proton-Pump Inhibitors in Children With Gastroesophageal Reflux Disease: A Systematic Review – https://pediatrics.aappublications.org/content/early/2011/04/04/peds.2010-2719.short
Proton Pump Inhibitor Use and the Risk of Chronic Kidney Disease – https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2481157?version=meter%20at%200&module=meter-
Links&pgtype=Blogs&contentId=&mediaId=%%ADID%%&referrer=https://www.google.com/&priority=true&action=click&contentCollection=meter-links-click
Effect of proton pump inhibitors on vitamins and iron – https://www.ncbi.nlm.nih.gov/pubmed/19262546
Proton pump inhibitors and bacterial overgrowth – https://www.ncbi.nlm.nih.gov/pubmed/16393275?dopt=Abstract
Proton pump inhibitor use and enteric infections – https://www.ncbi.nlm.nih.gov/pubmed/19262540?dopt=Abstract
Proton pump inhibitors and risk for recurrent Clostridium difficile infection – https://www.ncbi.nlm.nih.gov/pubmed/20458084
Therapy with gastric acidity inhibitors increases the risk of acute gastroenteritis and community-acquired pneumonia in children – https://www.ncbi.nlm.nih.gov/pubmed/16651285?dopt=Abstract
Proton Pump Inhibitors Interfere With Zinc Absorption and Zinc Body Stores – https://www.gastrores.org/index.php/Gastrores/article/view/379
Association of Long-term Proton Pump Inhibitor Therapy with Bone Fractures and effects on Absorption of Calcium, Vitamin B12, Iron, and Magnesium – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2974811/
Risk Factors for Esophageal Candidiasis – https://link.springer.com/article/10.1007/s100960050437
FDA Drug Safety Communication: Possible increased risk of fractures of the hip, wrist, and spine with the use of proton pump inhibitors – https://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm213206.htm