Hiatus hernia living in children

Overview

A hiatus hernia is when part of the stomach moves up into the chest through a small opening in the diaphragm, which is the muscle that helps you breathe. This can cause stomach acid to flow back into the food pipe, leading to symptoms like heartburn or spitting up.

Hiatus hernia in children is not very common. It affects a small number of children, but many cases are mild and improve with simple changes.

It can affect children of any age, from newborns to teenagers. Some children are born with a hiatus hernia, while others develop it later due to increased pressure in the abdomen.

Symptoms

Common symptoms

• heartburn (a burning feeling in the chest)
• regurgitation (food or sour liquid coming back up into the mouth)
• chest pain or discomfort
• difficulty swallowing
• feeling full quickly after eating

Symptoms in children

• vomiting or spitting up frequently
• irritability after feeding
• poor weight gain or slow growth
• coughing or wheezing, especially at night
• frequent ear infections
• bad breath or a sour taste in the mouth

Causes

Main causes

• weakness in the diaphragm muscle, often present from birth
• increased pressure in the abdomen from coughing, vomiting, or straining during bowel movements
• obesity or being overweight

Risk factors

• premature birth
• family history of hiatus hernia
• conditions that cause chronic coughing or vomiting, such as asthma or reflux
• obesity

When to see a doctor

See a doctor urgently if:

• if your child has difficulty breathing
• if your child has severe chest or abdominal pain
• if your child vomits blood
• if your child shows signs of dehydration

Book a routine appointment if:

• if your child has mild heartburn, spitting up, or discomfort after meals that does not improve with simple measures
• if your child is not gaining weight well
• if symptoms interfere with daily activities or sleep

Diagnosis

The doctor will ask about your child's symptoms and examine them. If needed, special tests can confirm the diagnosis.

Tests that may be done

• barium swallow test: drinking a chalky liquid followed by X-rays to see the shape of the food pipe and stomach
• endoscopy: a thin, flexible tube with a camera is passed into the food pipe and stomach to look for inflammation or other problems
• pH monitoring: a small tube measures how much acid flows back into the food pipe over 24 hours

What to expect at your appointment

These tests are usually done in a hospital or clinic. Your child may need to stop eating or drinking for a few hours before some tests. The doctor will explain everything and make sure your child is comfortable.

Treatment

Treatment focuses on reducing symptoms and preventing complications. Most children can be managed with lifestyle changes and, if needed, medication.

Self-care at home

• feed smaller meals more often throughout the day
• keep your child upright for at least 30 minutes after eating
• avoid foods that trigger symptoms, such as spicy, acidic, or fatty foods
• avoid tight clothing around the child's waist
• elevate the head of the bed by a few inches

Medical treatments

Doctors may recommend medicines to reduce stomach acid, such as antacids or acid-reducing medicines. Always talk to a doctor before giving any medicine to a child. Treatment is tailored to the child's age and symptoms.

When is surgery considered?

Surgery is rarely needed for children with hiatus hernia. It may be considered if symptoms are severe, do not improve with other treatments, or if there are complications like a strangulated hernia.

Living with this condition

With proper care, most children with a hiatus hernia live completely normal lives. You will learn to manage symptoms with feeding habits and positioning. It is important to watch for signs that symptoms are getting worse.

Lifestyle tips

• elevate the head of your child's bed or use a wedge pillow
• avoid large meals before bedtime
• encourage regular physical activity to maintain a healthy weight
• avoid activities that put pressure on the belly right after eating, like jumping or lying down

Diet and exercise

A balanced diet with plenty of fruits, vegetables, and whole grains is best. Avoid foods that cause symptoms. Regular exercise is good, but wait at least an hour after eating before active play. Staying at a healthy weight can help reduce pressure on the stomach.

Mental health and emotional wellbeing

Chronic symptoms like heartburn or spitting up can be frustrating for children. They may feel different or worry about eating. Reassure your child that this condition is manageable. If your child feels anxious or sad, talk to your doctor or a counselor.

Prevention

Hiatus hernia cannot always be prevented, especially if it is present from birth. However, maintaining a healthy weight, avoiding excessive pressure on the abdomen, and treating chronic cough or constipation may lower the risk.

Complications

If left untreated

• esophagitis: inflammation of the food pipe, which can cause pain and difficulty swallowing
• narrowing of the food pipe (stricture) from chronic inflammation
• breathing problems from stomach acid getting into the lungs, especially during sleep
• very rarely, a strangulated hernia where the stomach becomes trapped and loses blood supply, which is a medical emergency

Long-term outlook

The outlook for children with hiatus hernia is very good. With simple lifestyle changes and medical care if needed, most children have no long-term problems and many outgrow the condition as they get older.

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