Heartburn: Not Just for Adults Kids Get It Too

The American College of Gastroenterology recommends that your child avoid the following foods and beverages if he/she has GERD: Spicy, acidic, or tomato-based foods Fatty foods Citrus products (e.g., orange juice) Apple juice (apples are fine) Chocolate and licorice Caffeinated drinks (e.g., soda, coffee, tea, hot chocolate) All teenagers should also avoid smoking cigarettes and drinking alcohol. However, those with GERD have an added incentive, since these activities can worsen their symptoms. Gastroparesis , also known as delayed gastric emptying, may also contribute to GERD in children. When the stomach empties too slowly, it may cause bloating, increased acid secretion, and esophagitis (inflammation of the esophagus). Got Milk? Got GERD? Researchers have also considered whether milk might contribute to GERD. A study published in 2004 in the Journal of Pediatric Gastroenterology and Nutrition found an association between GERD and cow milk allergy in children. The study found that among 18 children with severe GERD, 10 were also allergic to cows milk. These same 10 had a significantly higher reflux index (a measurement of reflux severity) compared to those not allergic to cows milk.

Symptoms to Watch for in Your Child Symptoms of GERD in children include: Severe abdominal discomfort Lower chest pain Heartburn Sensation of food or liquid regurgitating into the throat or mouth Sensation of food stuck down in the throat Difficulty or pain while swallowing Hoarseness Vomiting Poor weight gain or weight loss Anemia (low iron count) Respiratory problems such as wheezing, cough, pneumonia , and asthma To help your child communicate how he or she is feeling and to better understand their symptoms, the Childrens Digestive Health and Nutrition Foundation suggest asking your child the following questions: Where does your tummy hurt? (Ask your child to point to where it hurts.) Does it hurt in your chest? Does it hurt when you eat or drink? Do you get a yucky or sour taste in your mouth? Does it taste like throw-up? Does food sometimes get stuck in your throat? Treating Your Childs GERD GERD can usually be diagnosed based on your childs symptoms and a physical exam. Additional diagnostic tests are not often required. Once the diagnosis is made, it can be treated through lifestyle changes, medication, and surgery.

Lifestyle Changes Changing your childs diet may relieve mild symptoms. Avoiding GERD trigger foods (listed previously) may be the first step. The doctor may also suggest feeding your child smaller meals and avoiding food 2-3 hours before bedtime. Finally, elevating your childs head at a 30 degree angle and having him or her sleep on their left side may also ease symptoms. Medication There are three classes of prescription medications to treat GERD: H2-blockers, proton pump inhibitors (PPIs), and prokinetic agents. H2-blockers and PPIs decrease the amount of acid in the stomach, while prokinetic agents strengthen the LES. Although there are some over-the-counter antacid medications that treat adult GERD, doctors do not recommend them for children. H2-Blockers vs. PPIs H2-blockers include Tagamet (cimetidine) and Zantac (ranitidine). PPIs include Nexium (esomeprazole), Prilosec (omeprazole), and Prevacid (lansoprazole). Although both classes of medications are effective, PPIs have been shown to relieve GERD symptoms in children who do not respond well to H2-blockers. Keep in mind, however, that doctors stress that PPIs are only for short-term use. Side effects of both H2-blockers and PPIs include diarrhea, dizziness, headaches, nausea, and vomiting. If your child has severe GERD, you should consult with a pediatric gastroenterologist to discuss a long-term treatment plan.

Prokinetic AgentsCaution When Given to Children Two prokinetic agents used to treat GERD are Reglan (metoclopramide) and Propulsid (cisapride). Common side effects include drowsiness and restlessness. Muscle spasms and jerky movements have also been seen in infants. More importantly, Propulsid has been associated with abnormal heart rhythms in children. In 2000, the drugs manufacturer, Janssen Pharmaceutica, stopped marketing Propulsid in the United States. It is now only available to select patients who have not been helped by other therapies. Surgery Surgery, such as a procedure called fundoplication , is rarely used to treat children with GERD. Rather, it is reserved for severe cases or when medications and lifestyle changes do not relieve symptoms. Surgery can carry a significant risk of complications and may even fail. Some studies report that more than half of patients that undergo surgery are back on medications because their symptoms return. In addition, some patients develop new symptoms that were not present before surgery. Take Action Now GERD can be an uncomfortable condition for both you and your child. But there is help available. Recognizing and relieving your childs symptoms now may benefit his or her health down the line.

by Marjorie M. Montemayor, MA RESOURCES: Childrens Digestive Health and Nutrition Foundation http://www.cdhnf.org International Foundation for Functional Gastrointestinal Disorders http://www.aboutgerd.org International Foundation for Functional Gastrointestinal Disorders: About Kids GI Disorders http://www.aboutkidsgi.org National Institute of Diabetes and Digestive and Kidney Diseases http://www.niddk.nih.gov North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition http://www.naspghan.org References: El-Serag HB, Gilger M, Carter J, et al. Childhood GERD is a risk factor for GERD in adolescents and young adults. Am J Gastroenterol . 2004 May;99(5):806-12. Gastroesophageal reflux (GERD)/acid reflux in infants and children. The Cleveland Clinic website. Available at: http://www.clevelandclinic.org/health/health-info/docs/3600/3642.asp?index=12010&src=news . Accessed October 21, 2005. Gastroesophageal reflux in children and adolescents. National Digestive Diseases Information Clearinghouse, National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/gerinchildren/ . Accessed October 17, 2005.

Gold BD. Gastroesophageal reflux disease: could intervention in childhood reduce the risk of later complications? Am J Med . 2004 Sep 6;117(Suppl 5A):23S-29S. Gold BD and Freston JW. Gastroesophageal reflux in children: pathogenesis, prevalence, diagnosis, and role of proton pump inhibitors in treatment . Pediatr Drugs . 2002;4(10): 673-685. Hassall E. Decisions in diagnosing and managing chronic gastroesophageal reflux disease in children. J Pediatr . 2005 Mar;146(Suppl 3):S3-12. Jung AD. Gastroesophageal reflux in infants and children. Am Fam Physician . 2001 Dec 1;64(11):1853-1860. Kay M and Vasundhara T. Common gastrointestinal problems in pediatric patients. American College of Gastroenterology website. Available at: http://www.acg.gi.org/patients/gihealth/pediatric.asp . Accessed October 17, 2005. Nielsen RG, Bindsley-Jensen C, Kruse-Andersen S, et al. Severe gastroesophageal reflux disease and cow milk hypersensitivity in infants and children: disease association and evaluation of a new challenge procedure. J Pediatr Gastroenterol Nutr . 2004 Oct;39(4):383-391. Pediatric gastroesophageal reflux: clinical practice guideline summary. Childrens Digestive Health and Nutrition Foundation, North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition website. Available at: http://www.cdhnf.org/pdf/GERD_8_pg_brochure_031604.pdf . Accessed October 13, 2005.

Pediatric GERD: frequently asked questions. Childrens Digestive Health and Nutrition Foundation, North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition website. Available at: http://www.cdhnf.org/faq.html . Accessed October 17, 2005. Questions to ask your child about how they feel. Childrens Digestive Health and Nutrition Foundation website. Available at: http://www.cdhnf.org/questions_child.html . Accessed October 19, 2005. Rudolph CD, Mazur LJ, Liptak GS, et al. Guidelines for evaluation and treatment of gastroesophageal reflux in infants and children: recommendations of the North American Society for Pediatric Gastroenterology and Nutrition. J Pediatr Gastroenterol Nutr . 2001;32(Suppl 2):S1-31. What you should know about gastroesophageal reflux (GER) in infants and children. American Family Physician website. Available at: http://www.aafp.org/afp/20011201/gastph.html . Accessed October 13, 2005. Last reviewed November 2005 by Richard Glickman-Simon, MD Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.