Acid Reflux in Children (Gastroesophageal Reflux)

Introduction

Acid reflux, or gastroesophageal reflux (GER), occurs when stomach contents flow back up into the esophagus. While mild reflux is common in infants and young children and often resolves on its own, persistent or severe symptoms may indicate gastroesophageal reflux disease (GERD), which can require medical attention. Understanding the signs, causes, and management of acid reflux in children is important for parents and caregivers.

Causes

Acid reflux in children is usually due to the immaturity of the lower esophageal sphincter (LES), the muscle that separates the stomach from the esophagus. In infants, the LES is not fully developed, making it easier for stomach contents to flow backward. Other contributing factors can include:

  • Overfeeding or large meals
  • Lying down soon after eating
  • Obesity
  • Certain foods or drinks (such as chocolate, citrus, or carbonated beverages)
  • Medical conditions that affect the digestive tract

Most infants outgrow reflux as their digestive system matures, usually by 12 to 18 months of age.

Symptoms

Symptoms of acid reflux in children can vary by age and severity. Common symptoms include:

  • Frequent spitting up or vomiting (especially in infants)
  • Irritability or fussiness during or after feeding
  • Refusal to eat or difficulty feeding
  • Poor weight gain or weight loss
  • Coughing, wheezing, or hoarseness
  • Heartburn or chest discomfort (more common in older children)
  • Trouble swallowing
  • Recurrent pneumonia or respiratory symptoms

Diagnosis

Diagnosis is based on a detailed medical history and physical examination. In most cases, no specific tests are needed for mild symptoms. If symptoms are severe, persistent, or associated with complications, a healthcare provider may recommend:

  • pH monitoring to measure acid levels in the esophagus
  • Upper gastrointestinal (GI) series (X-rays)
  • Upper endoscopy to examine the esophagus and stomach
  • Esophageal manometry to assess muscle function

Treatment Options

Most cases of acid reflux in children are mild and improve with simple measures:

  • Feeding smaller, more frequent meals
  • Keeping the child upright for at least 30 minutes after eating
  • Avoiding exposure to tobacco smoke
  • Elevating the head of the bed for older children
  • Avoiding trigger foods and drinks

If symptoms are more severe or do not improve, a healthcare provider may recommend:

  • Medications to reduce stomach acid (such as H2 blockers or proton pump inhibitors)
  • Thickening infant formula (under medical guidance)
  • Treating underlying medical conditions

Surgery is rarely needed and is reserved for severe, treatment-resistant cases.

Prevention

Preventing acid reflux in children involves:

  • Feeding infants in an upright position and burping them frequently
  • Avoiding overfeeding
  • Encouraging older children to eat slowly and avoid large meals
  • Maintaining a healthy weight
  • Avoiding foods and drinks that trigger symptoms

When to Seek Medical Care

Seek medical attention if your child:

  • Has poor weight gain or weight loss
  • Vomits blood or has blood in the stool
  • Has difficulty breathing, persistent cough, or wheezing
  • Experiences severe or persistent pain
  • Shows signs of dehydration (such as dry mouth, sunken eyes, or decreased urination)

Takeaway

Acid reflux is common in infants and children and usually resolves with age and simple care measures. Persistent or severe symptoms may indicate GERD and require medical evaluation. Early recognition and management can help prevent complications and support healthy growth.

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