1. Gastroesophageal Reflux in Infants and Children Melissa Velez

2. What is Gastroesophageal Reflux Disease?  When highly acidic contents of the stomach are refluxed back up to the esophagus These gastric contents irritate and sometimes damage mucosal surfaces of the esophagus It is a clinical condition that is severe enough to impact the patient’s life and/or damage the esophagus

3. Gastroesophageal Reflux in Infants  An infant will throw up after almost every feeding and many times between feedings.  This is usually due to an incoordination or immaturity of the upper respiratory tract.  Parents often worry that something more is wrong with the baby’s stomach Ulcer Not keeping enough food down to grow

4. Common Symptoms  It is unknown whether adults and infants have the same symptoms  Infants are most likely to have: Frequent or recurrent vomiting Heartburn Gas Abdominal pain

5. Symptoms Blamed on Reflux that are Less Common in Infants  Poor growth Unintentional limiting child’s caloric intake  Laryngeal Penetration In children with neurological impairments Aspirate refluxed stomach contents Swallow-breathe patterns are not well coordinated

6. Symptoms Blamed on Reflux (Continued)  Chronic congestion and hoarseness Results in stridor or laryngospasms  Chronic asthma Difficulty knowing whether reflux causes asthma or asthma causes reflux Reported incidence of reflux ranging between 46-75%

7. What happens with gastroesophageal reflux?  In children with reflux there is some incoordination of the upper intestinal tract  The infant will eat too fast but will not choke or gag during feedings which suggests that there is no difficulty getting food from their mouth to their esophagus  Since the stomach contracts normally, most of the time the infant will not be bothered by reflux

8. Differences Between Infants and Adults (Vomiting)  An infant with reflux or an adult with an intestinal flu virus An infant does not show discomfort before or after vomiting An adult will show symptoms of being sick beforehand such as nausea, sweating, salivating, and swallowing

9. Diagnosis  Usually hearing the parents story and seeing the child is enough to determine this problem  A few diagnostic tests that are given when further testing is recommended Barium Swallow or Upper GI series pH Probe Endoscopy

10. Barium Swallow  X-ray allowing doctors to follow food down the infants esophagus into the intestines  Doctor is able to see if there are twists, kinks, or a narrowing of the upper intestinal tract  Not very reliable

11. pH Probe  Performed by the use of a small wire with an acid sensor  Starts at the infants nose and ends at the bottom of the esophagus  Sensor is left in place for 12-24 hours  The severity of the reflux does not always correlate with the severity of the symptoms

12. Endoscopy  A flexible endoscope with lights and lenses are passed through the infants mouth.  Esophagitis Due to repeated exposure of the esophagus to stomach acid  Less than half of the infants with severe symptoms do not develop esophagitis

13. Treatment  Positioning the baby After feeding, put the baby on his stomach, and elevate the head  Changing feeding schedules Feed baby smaller amounts more often  Dietary treatments Parents are instructed to thicken their infants formula with cereal

14. Treatment Continued  Medications are used: Lessen intestinal gas Decrease or neutralize stomach acid Improve intestinal coordination  Surgery Extremely rare Nissen Fundoplication

15. Research  Recent experimental data suggests that Sudden Infant Death Syndrome (SIDS) may also be related to GERD.  Another study included 72 children with chronic cough and normal findings on chest radiographs, GERD was implicated as the casue of symptoms in 15 % of the patients.

16. References  Ahuja, V., Lassen, L., & Yencha, M. (1999, September). Head and neck manifestations of gastroesophageal reflux disease. American Family Physician, 60, 873-86.  Ashorn,M., Ruuska,T., & Karikoski,R. (2002, June). The natural course of gastroesophageal reflux disease in children. Scandinavian Journal of Gastroenterology, 37, 638-641.  Center for Voice Disorders of Wake Forest University. Sheet on reflux. Retrieved on March 29, 2003, from http://bgsm.edu/voice/pt_info.htmlhttp://bgsm.edu/voice/pt_info.html  Center for Voice Disorders of Wake Forest University. Reflux and voice disorders. Retrieved on March 29, 2003, from http://www.bgsm.edu/voice/reflux.html http://www.bgsm.edu/voice/reflux.html  Children’s Medical Center of the University of Virginia. Gastroesophageal Reflux in Infants. Retrieved on April 1, 2003, from http://www.people.virginia.edu/~smb4v/tutorials/reflux/ger.html