What Is Reflux in Children? Symptoms and Treatment Options

Reflux is a digestive system disorder characterized by the backflow of food mixture in the stomach toward the esophagus. In some children, stomach contents even reach the mouth and are swallowed back. This condition causes the esophagus and throat to become irritated by acid. For this reason, if precautions regarding reflux are not taken, serious health problems due to acid irritation may occur. It is most commonly seen in children under 2 years of age.

What Are the Symptoms of Reflux in Children?

Reflux can present differently in every child. Especially in children, the symptoms that occur vary by age. While the reflux symptoms of adolescents and young people resemble those of adults, young children experience symptoms similar to those of infants. The reflux symptoms in young children and newborn babies are as follows:

Painful burning sensation in the chest

Belching

Hiccups

Loss of appetite

Frequent vomiting

Hiccup episodes

Frequent coughing and nighttime coughing spells

Wheezing breathing

Heartburn

Regurgitation

Sour taste in the mouth

Bad breath

Stomach or abdominal pain

How Does Reflux Occur in Children?

The basic mechanism of reflux stems from a dysfunction of the lower esophageal sphincter located between the stomach and the esophagus. Stomach contents may flow back into the esophagus due to problems such as the sphincter not closing completely or opening at the wrong time. Especially in infants, the cause of reflux is generally the incomplete development of this sphincter. However, this is a temporary condition. As infants grow, the sphincter muscle fully develops and performs its normal function. The factors that may cause reflux in children are as follows:

Not keeping the child upright during feeding

Cigarette smoke

Overfeeding

Food allergies and intolerances

Hereditary metabolic diseases

Excessive consumption of foods that cause relaxation of the lower esophageal sphincter

Certain medications

Having a narrow and short esophagus

How Is Reflux in Children Diagnosed?

For diagnosing reflux in children and infants, a physical examination by a specialist physician is usually sufficient. However, in some cases, various tests may be used to diagnose reflux. The tests used to diagnose reflux in children are as follows:

Endoscopy: It is checked whether reflux has damaged the structure of the esophagus. If there is damage to the esophagus, it allows the severity of this damage to be assessed.

Esophageal pH monitoring: It is an effective method used to detect stomach acid in the esophagus. In addition to being used to diagnose reflux, it is also a method used to check the effectiveness of treatment.

Impedance-pH monitoring: It is a method similar to esophageal pH monitoring. The only difference is that it is used to diagnose both acid and non-acid reflux. It also allows the effectiveness of medications used in reflux treatment to be evaluated.

Barium swallow test: Also called an esophagram or upper GI series. It is an imaging test used to visualize the upper gastrointestinal system. The child is given a liquid containing barium. Barium coats the organs. In this way, the esophagus, stomach and the first part of the small intestine are visualized on X-ray.

Gastric emptying study: It is a test that examines the emptying of stomach contents into the small intestine. Delayed gastric emptying is a factor causing reflux. This test is aimed at investigating the cause of reflux.

How Is Reflux Treated in Children?

A specialist physician may recommend lifestyle changes, medication treatment and surgical intervention for reflux treatment in children. The doctor plans reflux treatment according to the child's age and symptoms. Most of the time, reflux in children improves with lifestyle changes. However, if symptoms do not improve despite following recommendations, or if symptoms seriously adversely affect the child's daily activities, sleep quality or general health, medication treatment is planned in addition to lifestyle changes.

Lifestyle Changes

Reflux treatment in children starts with improving feeding-related habits. Lifestyle change recommendations vary by age. Different applications may be recommended for infants and young children. The lifestyle changes recommended for infants are as follows:

The baby should be kept in an upright position for 30 minutes after feeding.

The baby should burp several times during breastfeeding and bottle feeding. Burping on a full stomach after feeding increases the risk of reflux.

Swallowing air by the baby during feeding should be prevented. Especially during bottle feeding or swallowing air due to pacifier-type nipples should be prevented.

Rice cereal can be added to formula to thicken it. In this way, reflux is prevented.

If the baby has an allergy to cow's milk protein and the baby is breastfed, the mother needs to remove cow's milk from her diet. This practice may help reduce the frequency of reflux symptoms.

Lifestyle recommendations for young children:

Children's plates should have smaller portions.

Mint, fried foods, chocolate, caffeinated drinks, citrus fruits and tomatoes should be limited in the diet.

Children should not lie down immediately after eating. Dinners should be served 2 hours before your child's bedtime.

Medication Treatment

For reflux that cannot be improved with lifestyle changes, the doctor may resort to medication treatment. The main goal of medication treatment is to block the mechanism causing reflux. For example, if reflux is caused by excessive stomach acid, medications that reduce acid production in the stomach are used. In this way, heartburn is prevented. Some medications may also be prescribed to speed up stomach emptying. Finally, medications that neutralize acid may be prescribed to reduce the harmful effects of acid. In the treatment of reflux, medications are prescribed to the child according to the underlying cause.

Surgical Intervention

It is a method applied in patients with severe reflux that cannot be improved with medication treatment and lifestyle changes. If the child cannot gain weight due to reflux and there is acid-related irritation in the esophagus, surgery is recommended. In addition, if children frequently suffer from respiratory diseases such as reflux cough, wheezing breathing and pneumonia, the doctor may include surgical intervention in the treatment plan. The most commonly used surgical procedure for reflux is fundoplication. With this procedure, the muscle of the lower esophageal sphincter is strengthened. In this way, complete closure is achieved.

If you observe reflux symptoms in your child, or if your child has a cough of unknown cause without reflux symptoms, do not neglect to consult a specialist physician. If your doctor first gave dietary recommendations, do not neglect to follow them.

Frequently Asked Questions About Reflux in Children

Reflux in babies starts before they are 8 weeks old. Over time, fewer signs of reflux are seen in the child. Reflux symptoms are commonly seen in 2-month-old babies. Reflux symptoms may continue to occur daily in 4-month-old babies. After 9 to 12 months, the frequency of reflux symptoms decreases. Usually, reflux disappears in children over 1 year old. Because the lower esophageal sphincter has not fully developed, food flows from the stomach toward the esophagus. This condition disappears after the sphincter development is completed. In addition to occurring physiologically, reflux may develop due to serious conditions such as allergies and eosinophilic esophagitis (inflammation of the esophagus). For diagnosis and treatment of reflux in infants and children, pediatric gastroenterology specialists should be consulted. Foods that trigger reflux or cause relaxation of the lower esophageal sphincter should be avoided. These are citrus fruits, caffeine-containing foods, chocolate, tomatoes, mint, spicy and fatty foods. Meals should consist of small portions whenever possible. Feeding should be done frequently. In addition, if obese or slightly overweight, support should be obtained from a specialist dietitian to reach a healthy weight. In healthy babies, physiological reflux occurs once or twice a day. However, if this does not harm the child's growth and development, there is no cause for concern. This condition is temporary. However, if there is a problem gaining weight, a specialist physician should be consulted. The doctor evaluates whether the baby has experienced reflux complications through medical history and physical examination. If the baby's symptoms indicate reflux, the doctor may give recommendations without resorting to tests. Especially in newborn babies, reflux treatment is based on recommendations about changes in the baby's feeding. It is quite difficult to distinguish whether a child is experiencing reflux cough. However, cough may be observed as a complication of reflux when stomach acid irritates the throat over time.

In babies and children, reflux usually resolves on its own; however, in some babies and children, medical intervention may be needed. If you notice symptoms in your child or baby such as feeding difficulties, frequent vomiting, restlessness or developmental delay, it is important to consult a specialist physician without delay.

As Hisar Hospital, we are by your side for your baby's health.

Click here to make an appointment with our specialist doctors, or contact us via our line at 0 (216) 524 13 00.