acid reflux in children

Overview

Acid reflux happens when stomach acid flows back up into the tube that carries food from your mouth to your stomach (called the esophagus). In children, this can cause spitting up, fussiness, or discomfort. When reflux happens often and causes problems, it is called gastroesophageal reflux disease (GERD).

Yes, acid reflux is very common in infants and young children. About half of all babies under 3 months spit up at least once a day, but the number drops sharply after 12 months.

It can affect any child, but it is most common in babies under 1 year old. Older children and teenagers may also get reflux, especially if they are overweight or eat foods that trigger it.

Symptoms

Common symptoms

• Frequent spitting up or vomiting
• Fussiness, crying, or irritability during or after feeding
• Arching the back during feeding
• Coughing or hiccupping after feeding
• Poor weight gain or weight loss

Symptoms in children

• For babies: projectile vomiting, refusing to eat, or screaming during feeds
• For toddlers and older children: a sour taste in the mouth, bad breath, or frequent burping
• For teens: heartburn (a burning feeling in the chest), regurgitation of food, or pain when swallowing

Symptoms in older adults

• This condition can affect older children in the same way as adults. In teenagers, symptoms may include a burning sensation in the chest, a dry cough, or the feeling of a lump in the throat. Older adults who have prolonged reflux should also be checked by a doctor.

Causes

Main causes

• A ring of muscle at the bottom of the esophagus is weak or relaxes at the wrong time
• The stomach empties too slowly
• The tube that carries food is too short or has a hiatal hernia
• Food allergies or sensitivities can make the stomach work harder

Risk factors

• Being born prematurely
• Lying flat most of the time (especially for infants)
• Eating large meals or lying down right after eating
• Being overweight or obese
• Eating spicy, fatty, or acidic foods
• Having a family history of reflux or GERD
• Using certain medicines (for example, some asthma treatments)

When to see a doctor

See a doctor urgently if:

• If your child has trouble swallowing or pain when swallowing
• If your child is not gaining weight or is losing weight
• If your child has blood in their vomit or stool
• If your child has a fever along with belly pain
• If reflux seems to cause trouble breathing

Book a routine appointment if:

• If your child spits up frequently and seems very uncomfortable
• If your child is irritable during or after every feeding
• If symptoms last more than a few weeks
• If over-the-counter feeding changes do not help (but always discuss with a doctor first)

Diagnosis

A doctor will usually diagnose reflux by listening to your child’s symptoms and doing a physical exam. In many cases, no tests are needed. If symptoms are severe or do not improve, your doctor may suggest further tests to look inside the food pipe or measure acid levels.

Tests that may be done

• An upper GI series (a special X-ray of the stomach and esophagus) to check for blockages or swallowing problems
• An endoscopy, where a thin, flexible tube with a camera is used to look inside the esophagus and stomach
• A pH study, which measures how often acid comes back up into the esophagus
• A feeding test or allergy test if food sensitivities are suspected

What to expect at your appointment

For most children, the diagnosis is made in the doctor’s office simply by talking about the symptoms. If a test is needed, it may mean a trip to a hospital clinic or specialist. The tests are usually quick but may require your child to fast (not eat or drink) for a few hours beforehand. The doctor will explain exactly what will happen and how to prepare your child.

Treatment

Treatment for acid reflux in children usually starts with simple lifestyle and feeding changes. If those are not enough, a doctor may suggest medicine to reduce stomach acid. Surgery is rarely needed and only considered when medicines do not work or when reflux causes very serious problems.

Self-care at home

• Feed smaller, more frequent meals
• Burp your baby frequently during and after feeds
• Keep your child upright for 30 minutes after eating, not lying down
• Avoid giving acidic foods, caffeine, fizzy drinks, and very fatty or spicy foods to older children
• Make sure your child does not eat too close to bedtime
• Elevate the head of your child’s bed if the doctor suggests it (for older children)
• Help your child maintain a healthy weight through diet and activity

Medical treatments

If lifestyle changes do not control the symptoms, a doctor may suggest a medication that reduces stomach acid. These are usually safe for children, but they should only be used under a doctor’s guidance. Never give your child an over-the-counter acid reducer without asking your doctor first. Treatment plans are tailored to your child’s age, symptoms, and overall health.

When is surgery considered?

In very rare cases, if reflux is life-threatening or makes it impossible for a child to grow, a surgeon may recommend a procedure called fundoplication. This surgery tightens the valve at the bottom of the esophagus. It is a major operation and is only considered after all other treatments have failed.

Living with this condition

Living with a child who has reflux can be stressful, but most children outgrow it with time. Stick to a routine that avoids long gaps between meals, and keep your child upright after eating. Keep a diary of symptoms to help your doctor see what works and what does not.

Lifestyle tips

• Keep mealtimes calm and relaxed
• Avoid overfeeding – stop when your child shows signs of fullness
• Use an infant seat or a sling to keep your baby upright after feeding
• Encourage your child to chew food well and eat slowly
• Make sure your child sleeps on their back (for infants) unless your doctor says otherwise

Diet and exercise

For babies, breastmilk is usually best. If you formula-feed, ask your health visitor about thickened feeds or a different formula. For older children, reduce fatty foods, chocolate, mint, spicy foods, citrus, and caffeine. Regular physical activity helps with weight control and digestion, but avoid vigorous exercise right after meals.

Mental health and emotional wellbeing

Caring for a child in pain can be exhausting and worrying. You may feel stressed or frustrated. It is normal to feel this way. Do not blame yourself, and reach out to your child’s doctor if you feel overwhelmed. Every one of these symptoms can be managed with help.

Prevention

You cannot always prevent reflux, especially in infants, but you can reduce the chances of it causing problems. Feed your child smaller meals, avoid giving foods that trigger symptoms, and keep your child upright after eating. Helping your child stay at a healthy weight and avoiding secondhand smoke can also lower the risk.

Vaccines

Vaccines do not prevent reflux, but keeping your child up to date on routine vaccinations helps protect them from illnesses that can make reflux worse, such as whooping cough.

Screening programmes

There is no routine screening test for acid reflux in children. If your child has symptoms, your healthcare provider will assess them during regular check-ups or whenever you visit with a concern.

Complications

If left untreated

• Inflammation of the food pipe (esophagitis), which can cause pain and make swallowing difficult
• Bleeding in the food pipe, which may lead to anemia
• Stricture (narrowing) of the food pipe from scarring
• Poor growth or failure to thrive from pain or refusals to eat
• Breathing problems like asthma, cough, or recurrent pneumonia
• Dental problems from acid coming into the mouth

Long-term outlook

The good news is that most children with acid reflux get better with simple changes, and it often resolves on its own as they grow. Even when treatment is needed, with the right support and care, children can eat comfortably, grow well, and live happy, active lives.

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