{"id":57997,"date":"2024-10-31T13:26:38","date_gmt":"2024-10-31T13:26:38","guid":{"rendered":"https:\/\/cdhf.staging.not4prod.com\/?p=57997"},"modified":"2024-12-18T20:45:26","modified_gmt":"2024-12-18T20:45:26","slug":"pediatric-gastroesophageal-reflux-disease-gerd","status":"publish","type":"post","link":"https:\/\/cdhf.ca\/en\/pediatric-gastroesophageal-reflux-disease-gerd\/","title":{"rendered":"Pediatric Gastroesophageal Reflux Disease (GERD)"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\">November is GERD Awareness Month! This month, our focus is on Pediatric Gastroesophageal Reflux Disease (GERD). Stay informed by learning the key signs, symptoms, and available treatment options to help manage this condition effectively.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">What is Gastroesophageal Reflux Disease (GERD)?<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Gastroesophageal reflux (GER) is a common condition in infants and children where stomach contents such as food and acid move back up into the esophagus. It can occur with or without regurgitation or vomiting.<sup>1<\/sup> About 20% of healthy babies at 1 month have spit-ups or vomiting following most feeds and this increases to about 41% of babies who are 3-4 months old.<sup>2<\/sup> Usually this improves after 1 year of age but can also occur in children and teenagers. If an infant is healthy, comfortable, and growing well, reflux is not a cause for concern. However sometimes gastroesophageal reflux can cause troublesome symptoms and lead to complications. When this occurs, we call it gastroesophageal reflux disease (<a href=\"https:\/\/cdhf.ca\/en\/digestive-conditions\/gerd\/\">GERD<\/a>).<sup>1<\/sup><\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe title=\"What is Pediatric GERD?\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/fBjjQ-rV5i0?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>What are the symptoms of Pediatric Gastroesophageal Reflux Disease (GERD)?<\/strong><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The symptoms of GERD can be different based on age and can also be caused by conditions other than reflux. In babies, it can be difficult to determine if they have gastroesophageal reflux disease because many of the symptoms are non-specific and can be present as normal behaviours all babies experience. In infants with GERD, some of the symptoms they can experience include discomfort, fussiness, crying, and arching of the back. Some of the gastrointestinal symptoms can including frequent regurgitation, failure to thrive, and feeding refusal.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Research has shown that often there isn\u2019t a strong link between the acid levels and these symptoms which makes it difficult to decide when treatment is needed. Additionally, there is no single test or method that is considered the best or most accurate for diagnosing GERD.<sup>2<\/sup><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">When children are older, it is easier for them to communicate their symptoms. At this age, the symptoms are more in common with the symptoms seen in adults such as heartburn, abdominal pain, regurgitation, and cough.<sup>3<\/sup><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Symptoms of GERD are more common and tend to be more severe in children that have other medical conditions such as prematurity, structural problems with their esophagus, neurologic impairments, cystic fibrosis, or hiatal hernias.<\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe title=\"Signs of Pediatric GERD\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/jbUMdROfOms?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">Signs and symptoms that may suggest an alternative diagnosis or require further investigation by a health professional include:<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">General<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Weight loss<\/li>\n\n\n\n<li>Lethargy<\/li>\n\n\n\n<li>Fever<\/li>\n\n\n\n<li>Excessive pain or irritability &nbsp;<\/li>\n\n\n\n<li>Worsening symptoms especially in children<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"data:image\/gif;base64,R0lGODlhAQABAIAAAAAAAP\/\/\/yH5BAEAAAAALAAAAAABAAEAAAIBRAA7\" data-src=\"https:\/\/cdhf.ca\/wp-content\/uploads\/2024\/10\/Banners-for-Website-Size-92-1024x461.webp\" alt=\"pediatric gerd symptms\" class=\"wp-image-57999 lazyload\"\/><noscript><img decoding=\"async\" src=\"https:\/\/cdhf.ca\/wp-content\/uploads\/2024\/10\/Banners-for-Website-Size-92-1024x461.webp\" alt=\"pediatric gerd symptms\" class=\"wp-image-57999 lazyload\"\/><\/noscript><\/figure>\n\n\n\n<h3 class=\"wp-block-heading\">Neurological<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Seizures<\/li>\n\n\n\n<li>Headaches<\/li>\n\n\n\n<li>Changes to head size<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Gastrointestinal<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Persistent forceful vomiting<\/li>\n\n\n\n<li>Nocturnal vomiting<\/li>\n\n\n\n<li>Green (bilious) vomit<\/li>\n\n\n\n<li>Bloody vomit<\/li>\n\n\n\n<li>Chronic diarrhea<\/li>\n\n\n\n<li>Bloody diarrhea<\/li>\n\n\n\n<li>Distension of the stomach<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>What are the causes of GERD?<\/strong><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The main cause of pediatric gastroesophageal reflux disease is abnormal relaxation of the valve between the esophagus (swallowing tube) and the stomach. This connection valve is a ring shaped muscle called the lower esophageal sphincter (LES). When we swallow, the LES opens to allow for food or liquids to enter the stomach and then closes to prevent food and stomach contents flowing back into the esophagus. When not eating, the LES should remain closed to keep stomach contents in the stomach. Compared to older children, the LES does not always open and close as much as it is supposed to in babies as it has not fully developed. Reflux is more common in babies because their diet consists exclusively of liquids and they spend long periods of time laying down compared to toddlers. Over time, this muscle matures and helps to keep the LES closed when children are not swallowing and help to keep the stomach contents out of the esophagus.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A less common cause for GERD can be difficulties with food moving through the esophagus or with stomach contents moving out of the stomach into the small intestine.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Sometimes symptoms similar to GERD can be caused from other conditions such as eosinophilic esophagitis, pyloric stenosis, and food intolerance such as cow\u2019s milk protein allergy. These conditions would need further assessment by a medical professional.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"data:image\/gif;base64,R0lGODlhAQABAIAAAAAAAP\/\/\/yH5BAEAAAAALAAAAAABAAEAAAIBRAA7\" data-src=\"https:\/\/cdhf.ca\/wp-content\/uploads\/2024\/10\/Banners-for-Website-Size-94-1024x461.webp\" alt=\"what is pediatric gastroesophageal reflux disease\" class=\"wp-image-58005 lazyload\"\/><noscript><img decoding=\"async\" src=\"https:\/\/cdhf.ca\/wp-content\/uploads\/2024\/10\/Banners-for-Website-Size-94-1024x461.webp\" alt=\"what is pediatric gastroesophageal reflux disease\" class=\"wp-image-58005 lazyload\"\/><\/noscript><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Stages\/Erosive &amp; Non-Erosive<\/strong><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The timing of symptoms is important to characterize the reflux event. When symptoms occur during or right after a meal, what is coming up is breast milk or formula and should typically be considered a non-acidic reflux event.<sup>4<\/sup> Medication is not often helpful in this situation.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Symptoms of GERD do not always mean there are changes or damage to the lining of the esophagus. However, abnormal acid exposure in the esophagus can cause changes to the lining of the esophagus which is known as erosive esophagitis. Untreated GERD with features of erosive esophagitis can lead to complications such as ongoing pain, bleeding, narrowing of the esophagus, and permanent changes to the lining of the esophagus.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>What is the Management and Treatment of GERD?<\/strong><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The management and treatment of GERD depends on the symptoms the baby or child is experiencing and on their age. If an infant is growing well, treatments aimed at GERD are unlikely to help and can lead to unnecessary investigations and potential overtreatment.<sup>1<\/sup><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">For infants who are having troublesome symptoms from GERD or concerns with feeding or growth, doctors usually start with simple and safe changes rather than starting with treatments that can have added risks or side effects. For some infants GERD is improved by avoiding overfeeding. Your healthcare provider may review the volumes of the feed and how often your baby is eating along with their growth to make sure they are getting the right amount of food. Another option is using thickened feeds which can help to limit the amount of regurgitation or vomiting your baby is experiencing by thickening the breast milk or formula. Your doctor or dietician can help provide recommendations about how to thicken feeds. Other changes such as: infant positioning, pre and probiotics, massage therapy, and herbal medications are not recommended to treat GERD as there is a lack of research that has shown benefit from these treatments.<sup>1<\/sup> <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The Canadian Paediatric Society recommends placing infants in a supine position for sleep, on a flat surface, based on strong evidence that this position helps prevent sudden infant death syndrome.<sup>5<\/sup> Infants should not be placed in other positions to sleep to prevent GERD. In older children, if they can identify triggers such as foods, coffee, positioning, or lack of sleep it is important for children to try to eliminate or limit triggers to see if there is an improvement to their symptoms.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">If the previous options are not helpful, sometimes doctors will recommend your baby try a 2-4 week trial of special formula where the protein is more broken, known as extensively hydrolysed protein based formula or amino acid based formula. This can be helpful because the symptoms of GERD and Cow\u2019s milk protein allergy can overlap making it difficult to determine the cause of the infant\u2019s symptoms.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">If these options are not helpful, sometimes infants will need to be seen by a doctor who has experience in treating infants with GERD. This can include your family doctor, pediatrician, or pediatric gastroenterologist. Medications called proton pump inhibitors can be used to help reduce the symptoms of GERD. Proton pump inhibitors (PPIs) are medications that stop the production of acid in the stomach. These medications are usually used for 4-8 weeks to see if there are improvements to the child\u2019s symptoms. Sometimes a different kind of medication called histamine-2 receptor antagonists (H<sub>2<\/sub>RAs) will be used if PPIs are not available or cannot be used. The goal for medication therapy is to use the lowest dose for the shortest amount of time as possible.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"data:image\/gif;base64,R0lGODlhAQABAIAAAAAAAP\/\/\/yH5BAEAAAAALAAAAAABAAEAAAIBRAA7\" data-src=\"https:\/\/cdhf.ca\/wp-content\/uploads\/2024\/10\/Banners-for-Website-Size-93-1024x461.webp\" alt=\"pediatric gastroenterologist for pediatric gerd\" class=\"wp-image-58001 lazyload\"\/><noscript><img decoding=\"async\" src=\"https:\/\/cdhf.ca\/wp-content\/uploads\/2024\/10\/Banners-for-Website-Size-93-1024x461.webp\" alt=\"pediatric gastroenterologist for pediatric gerd\" class=\"wp-image-58001 lazyload\"\/><\/noscript><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">When children do not respond to the above treatments, it is important to reassess the medications, treatment goals, and to ensure there is no other cause for the symptoms. Sometimes more invasive investigations may need to be completed such as an upper endoscopy which helps to look at the area with a camera and take biopsies to see if there are any changes to the cells under the microscope. Another investigation includes pH impedance testing which helps measure the amount of acid and flow of stomach contents into the esophagus. A pediatric gastroenterologist will help decide if or when these investigations would be required.<\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe title=\"Managing Pediatric GERD\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/tTlmE_H5t0U?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n<div class=\"gradient-divider\"><\/div><div class=\"sponsor-block\"><p><p><span style=\"color:rgb(0,0,0);\">This brochure was made possible through an unrestricted educational grant from Viatris.<\/span><\/p><\/p><div class=\"sponsor-details\"><div class=\"photo\" >\n<a target=\"_blank\" href=\"https:\/\/www.viatris.com\/en-ca\/lm\/Canada\"><img decoding=\"async\" class=\"lazyload\" src=\"data:image\/gif;base64,R0lGODlhAQABAIAAAAAAAP\/\/\/yH5BAEAAAAALAAAAAABAAEAAAIBRAA7\" data-src=\"https:\/\/cdhf.ca\/wp-content\/uploads\/2022\/08\/Vatris-logo.webp\"  \/><noscript><img decoding=\"async\" class=\"lazyload\" src=\"https:\/\/cdhf.ca\/wp-content\/uploads\/2022\/08\/Vatris-logo.webp\"  \/><\/noscript><\/a>\n<\/div>\n        <\/div><\/div>\n\n\n<p class=\"wp-block-paragraph\"><strong>References<\/strong><\/p>\n\n\n\n<ol class=\"wp-block-list\">\n<li>Rosen, R.&nbsp;<em>et al.<\/em>&nbsp;(2018) \u2018Pediatric gastroesophageal reflux clinical practice guidelines\u2019,&nbsp;<em>Journal of Pediatric Gastroenterology and Nutrition<\/em>, 66(3), pp. 516\u2013554.<\/li>\n\n\n\n<li>Martin, A.J.&nbsp;<em>et al.<\/em>&nbsp;(2002) \u2018Natural history and familial relationships of infant spilling to 9 years of age\u2019,&nbsp;<em>Pediatrics<\/em>, 109(6), pp. 1061\u20131067.<\/li>\n\n\n\n<li>Gupta, S.K.&nbsp;<em>et al.<\/em>&nbsp;(2006) \u2018Presenting symptoms of nonerosive and erosive esophagitis in pediatric patients\u2019,&nbsp;<em>Digestive Diseases and Sciences<\/em>, 51(5), pp. 858\u2013863.<\/li>\n\n\n\n<li>Jung, W.J.&nbsp;<em>et al.<\/em>&nbsp;(2012) \u2018The efficacy of the upright position on gastro-esophageal reflux and reflux-related respiratory symptoms in infants with chronic respiratory symptoms\u2019,&nbsp;<em>Allergy, Asthma and Immunology Research<\/em>, 4(1), p. 17. doi:10.4168\/aair.2012.4.1.17.&nbsp;<\/li>\n\n\n\n<li>Chevalier, I.&nbsp;<em>et al.<\/em>&nbsp;(2022) \u2018Medical Management of gastro-esophageal reflux in healthy infants\u2019,&nbsp;<em>Paediatrics &amp;amp; Child Health<\/em>, 27(8), pp. 503\u2013506.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>November is GERD Awareness Month! This month, our focus is on Pediatric Gastroesophageal Reflux Disease (GERD). Stay informed by learning the key signs, symptoms, and available treatment options to help manage this condition effectively. What is Gastroesophageal Reflux Disease (GERD)? Gastroesophageal reflux (GER) is a common condition in infants and children where stomach contents such [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":58046,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"cdhf2022_sponsors_meta":[],"footnotes":""},"categories":[60],"tags":[50],"class_list":["post-57997","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-article","tag-tags-gerd"],"acf":{"article_writer":[58008]},"featured_image_src":"https:\/\/cdhf.ca\/wp-content\/uploads\/2024\/10\/Banners-for-Website-Size-96.webp","author_info":{"display_name":"Kelsey Cheyne","author_link":"https:\/\/cdhf.ca\/en\/author\/kelsey-cheyne\/"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.1.1 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Pediatric Gastroesophageal Reflux Disease (GERD) - Canadian Digestive Health Foundation<\/title>\n<meta name=\"description\" content=\"Pediatric Gastroesophageal Reflux Disease is a common condition where stomach contents such as food &amp; acid move back up into the esophagus.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/cdhf.ca\/en\/pediatric-gastroesophageal-reflux-disease-gerd\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Pediatric Gastroesophageal Reflux Disease (GERD) - 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