1. Gastroesophageal
Reflux in Infants and Children
Melissa Velez

2. What is Gastroesophageal Reflux
Disease?
 When highly acidic contents of the stomach
are refluxed back up to the esophagus
 These gastric contents irritate and sometimes
damage mucosal surfaces of the esophagus
 It is a clinical condition that is severe enough
to impact the patient’s life and/or damage the
esophagus

3. Gastroesophageal Reflux in
Infants
 An infant will throw up after almost every
feeding and many times between feedings.
 This is usually due to an incoordination or
immaturity of the upper respiratory tract.
 Parents often worry that something more is
wrong with the baby’s stomach
 Ulcer
 Not keeping enough food down to grow

4. Common Symptoms
 It is unknown whether adults and infants
have the same symptoms
 Infants are most likely to have:
 Frequent or recurrent vomiting
 Heartburn
 Gas
 Abdominal pain

5. Symptoms Blamed on Reflux
that are Less Common in Infants
 Poor growth
 Unintentional limiting child’s caloric intake
 Laryngeal Penetration
 In children with neurological impairments
 Aspirate refluxed stomach contents
 Swallow-breathe patterns are not well
coordinated

6. Symptoms Blamed on Reflux
(Continued)
 Chronic congestion and hoarseness
 Results in stridor or laryngospasms
 Chronic asthma
 Difficulty knowing whether reflux causes asthma
or asthma causes reflux
 Reported incidence of reflux ranging between
46-75%

7. What happens with
gastroesophageal reflux?
 In children with reflux there is some incoordination
of the upper intestinal tract
 The infant will eat too fast but will not choke or gag
during feedings which suggests that there is no
difficulty getting food from their mouth to their
esophagus
 Since the stomach contracts normally, most of the
time the infant will not be bothered by reflux

8. Differences Between Infants
and Adults (Vomiting)
 An infant with reflux or an adult with an
intestinal flu virus
 An infant does not show discomfort before or
after vomiting
 An adult will show symptoms of being sick
beforehand such as nausea, sweating,
salivating, and swallowing

9. Diagnosis
 Usually hearing the parents story and seeing
the child is enough to determine this problem
 A few diagnostic tests that are given when
further testing is recommended
 Barium Swallow or Upper GI series
 pH Probe
 Endoscopy

10. Barium Swallow
 X-ray allowing doctors to follow food down
the infants esophagus into the intestines
 Doctor is able to see if there are twists,
kinks, or a narrowing of the upper intestinal
tract
 Not very reliable

11. pH Probe
 Performed by the use of a small wire with an
acid sensor
 Starts at the infants nose and ends at the
bottom of the esophagus
 Sensor is left in place for 12-24 hours
 The severity of the reflux does not always
correlate with the severity of the symptoms

12. Endoscopy
 A flexible endoscope with lights and lenses
are passed through the infants mouth.
 Esophagitis
 Due to repeated exposure of the esophagus to
stomach acid
 Less than half of the infants with severe
symptoms do not develop esophagitis

13. Treatment
 Positioning the baby
 After feeding, put the baby on his stomach, and
elevate the head
 Changing feeding schedules
 Feed baby smaller amounts more often
 Dietary treatments
 Parents are instructed to thicken their infants
formula with cereal

14. Treatment Continued
 Medications are used:
 Lessen intestinal gas
 Decrease or neutralize
stomach acid
 Improve intestinal
coordination
 Surgery
 Extremely rare
 Nissen Fundoplication

15. Research
 Recent experimental data suggests that
Sudden Infant Death Syndrome (SIDS) may
also be related to GERD.
 Another study included 72 children with
chronic cough and normal findings on chest
radiographs, GERD was implicated as the
casue of symptoms in 15 % of the patients.

16. References
 Ahuja, V., Lassen, L., & Yencha, M. (1999, September). Head and
neck manifestations of gastroesophageal reflux disease. American
Family Physician, 60, 873-86.
 Ashorn,M., Ruuska,T., & Karikoski,R. (2002, June). The natural
course of gastroesophageal reflux disease in children. Scandinavian
Journal of Gastroenterology, 37, 638-641.
 Center for Voice Disorders of Wake Forest University. Sheet on reflux.
Retrieved on March 29, 2003, from http://bgsm.edu/voice/pt_info.html
 Center for Voice Disorders of Wake Forest University. Reflux and
voice disorders. Retrieved on March 29, 2003, from http://www.bgsm.
edu/voice/reflux.html
 Children’s Medical Center of the University of Virginia.
Gastroesophageal Reflux in Infants. Retrieved on April 1, 2003, from
http://www.people.virginia.edu/~smb4v/tutorials/reflux/ger.html