Gastroesophageal Reflux (GERD): What Is It, and What Can Be Done?

Under normal conditions, the muscle at the lower end of the esophagus relaxes when letting food in and contracts to block the food from traveling back into the esophagus. This muscle, the lower esophageal sphincter (LES), can also cause problems. Sometimes the LES is loose and does not close, or it opens at the wrong time. As a result, food and stomach acid can come back up and may be vomited. In many cases, this is diagnosed as Gastroesophageal Reflux Disease, or GERD.

What Are the Symptoms of GERD?

The most common symptom of GERD in infants is spitting up or vomiting, which is often forceful and followed by crying. Pain from esophageal irritation can cause difficulty in eating or refusal to eat altogether, along with crankiness during feeding.

Other symptoms may include:

  • Gagging
  • Choking
  • Wet burps
  • Hiccups

Frequent coughing may be present, and the child may draw up their legs or arch their body in response to the burning sensation in the esophagus. Failure to gain weight, restless sleep, and asthma or even recurring pneumonia could also occur.

GERD is often mistaken for colic because both conditions may feature prolonged periods of crying. The good news is that most infants outgrow it by age one without major medical intervention.

GERD Infant Care

Babies suffering from GERD should be held upright when feeding and burped frequently, preferably in an upright position over the shoulder as opposed to being seated. Over-feeding may increase GERD symptoms and should be avoided. Feeding every two to four hours during the day and on demand at night are recommended. Follow safe sleep guidelines including putting baby ALONE, ON THEIR BACK, IN THE CRIB, and watch for reflux symptoms during the day when using other infant equipment like swings and bouncy chairs.

Your pediatrician may recommend that you eliminate cow’s milk – either from your diet if you nurse or by switching to a less allergenic formula – because reflux symptoms can be caused by the irritation caused by certain milk proteins to the stomach and the intestine. Antacids or acid blockers might be prescribed by a doctor in more severe cases. Do not ever give these medications to an infant without being under a doctor’s care. Your pediatrician may order x-rays, scopes of the digestive tract or other tests to ensure that GERD is the correct diagnosis.

When Should You Call the Pediatrician?

Contact your child’s doctor if your baby presents these symptoms:

  • Weight loss or failure to gain
  • Blood streaks in baby’s vomit
  • Breathing problems
  • A high fever (over 100 degrees Fahrenheit) when taken under the arm
  • Constant crying
  • Baby seems to be in pain
  • Vomiting frequency increases
  • Baby seems dehydrated

Of course, if your baby seems miserable from the reflux or if weight gain is being affected, it’s a good idea to call your pediatrician for an appointment anyway, in order to ease your mind and find out how you can comfort your baby.

Click here for more information on the Nationwide Children’s Hospital Motility Center or listen to our PediaCast.

Carlo Di Lorenzo, MD
Carlo Di Lorenzo, MD, is Chief of the Division of Pediatric Gastroenterology, Hepatology and Nutrition at Nationwide Children's Hospital where he holds the Robert F. and Edgar T. Wolfe Foundation Endowed Chair in Pediatric Gastroenterology and Professor of Clinical Pediatrics at The Ohio State University College of Medicine. Dr. Di Lorenzo has been among the first clinical investigators to assess the diagnostic value of antroduodenal and colonic manometry and to use the electronic barostat to assess visceral sensitivity in children. He co-authored the only two books on pediatric gastrointestinal motility and has published more than 190 peer-reviewed original articles and 80 chapters, invited reviews and editorials. He has been awarded the Master Award in Gastroenterology for Basic or Clinical research in Gastroenterology by the AGAI, the Golden Stethoscope Award by Nationwide Children’s Hospital and the Award for Senior Investigator in Pediatrics by the IFFGD. He is currently the President of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition.

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