SUNDAY, May 25, 2003 (HealthDayNews) -- Carolyn McGraw was beside herself. Her newborn daughter, Lauren, seemed like she was in constant misery.
She howled through the day and night. She spit up so often that at 4 weeks old, she was severely underweight.
"I felt helpless," says McGraw, who lives in southern California. "I was a new mom, and despite all the comforting and holding my child, she was still writhing in pain."
Lauren endured test after test until finally, doctors diagnosed her problem -- gastroesophageal reflux disease, or GERD. It occurs when a valve in the esophagus malfunctions, allowing the acidic contents of the stomach to flow back into the esophagus.
Once thought to be an adult disease, there's increasingly awareness among pediatricians and parents that GERD is a relatively common childhood ailment that appears anytime between the first few weeks of life and the teen years.
According to a recent study in the Archives of Pediatrics and Adolescent Medicine, GERD "is a common disease of infancy with a prevalence as high as 18 percent in [otherwise] healthy children."
Dr. Bill Sears, a pediatrician in San Clemente, Calif., says, "For a child with GERD, it hurts them to eat and it hurts them to sleep, so they learn to associate eating and sleeping with pain rather than pleasure. But they're too young to describe the feeling. When I see them in my office, the parents say, 'I know my child hurts somewhere.'"
GERD is often dismissed as mere colic, which really isn't a medical condition at all, but mainly a description for a fussy baby who cries a lot, he says.
"GERD is one of the most commonly missed diagnoses," Sears says. "Many so-called colicky babies really have GERD and nobody knows about it."
What makes GERD easy to miss is that it's normal and common for infants to spit up several times a day, says Dr. William Cochran, chairman of the American Academy of Pediatrics' section of gastroenterology and nutrition.
"I call them the 'happy spitters,'" Cochran says. "All babies have reflux. It's OK if the baby spits up once a day or 10 times a day, as long as the baby is happy and if there are no other problems. About 90 to 95 percent of them will outgrow it by 1 year of age."
It's only when the vomiting is accompanied by pain and other problems that it becomes a disease. Severe GERD can lead to everything from bleeding in the esophagus to sinus and respiratory ailments. GERD that goes unchecked for many years can even increase the chances of esophageal cancer, Cochran says.
"If the baby is distressed, if the baby is not eating and not gaining weight, if they're not sleeping well and are irritable, that's when it becomes a disease," he says.
The respiratory problems occur because the openings to the trachea, also known as the windpipe, and the esophagus, which carries food to the stomach, are next to each other. When the baby regurgitates, tiny food particles can get into the lungs and the sinuses.
In a study of children with chronic sinus problems, Cochran and his colleagues found treating the reflux improved the sinus condition in about 80 percent of the children.
There are many degrees of reflux, Sears says. Some children have mild cases that can be relieved by making simple lifestyle changes.
When Sears suspects GERD, among the first things he advises are:
- Position your baby on the left side when you put him or her to sleep. This lets gravity help keep the food down. Also, keep your child upright for at least half an hour after eating.
- Feed a child smaller, more frequent meals. In older children, avoid
fatty foods, caffeine, tomato/citrus products, carbonated beverages, spicy foods and junk food.
- Elevate the head of your child's bed.
- Protect the child from secondhand cigarette smoke.
If these changes don't provide relief, Sears says parents can try several types of medication, including:
- H2 blockers, prescription medicines that partially block the production of stomach acid to let the esophagus heal. One brand name: Zantac.
- Proton pump inhibitors, prescription acid suppressant medications that block the final stage of acid production in the stomach. One brand name: Prevacid.
For those children with a serious form of the disease who aren't helped by any of these treatments, surgery is an option.
By age 5, Lauren was so ill she needed an operation called a fundoplication, in which surgeons wrap a band of muscle around the lower esophagus to tighten the malfunctioning valve.
The causes of GERD are not known, although a study of five families who had more than one child with severe pediatric GERD found what appeared to be a genetic marker on chromosome 13. The study was published in 2000 in the Journal of the American Medical Association.
The McGraws, one of the five families that took part in the study, are pretty sure if there is a GERD gene, they have it. Their second daughter, Kristen, was born with mild reflux. They later had twin boys, Ian and Shaun, who were both born with severe reflux.
And at 8, Lauren needed a second lifesaving surgery.
"It was very, very difficult on me and my husband," McGraw says. "We went for years where we only got a few hours of sleep a night."
Seeing the agony her children went through, McGraw got involved with the Pediatric/Adolescent Gastroesophageal Reflux Association (PAGER), an organization dedicated to raising awareness of GERD. She served as co-director for several years before resigning a few months ago to focus more on raising funds for genetic research.
"No child should have to suffer and no child should have to be in pain," she says.
The McGraws' children, now 16, 14 and 10, are doing better. Lauren, Ian and Shaun take proton pump inhibitors, but they still struggle with reflux-induced asthma, chronic sinus problems, sleepless nights and bouts of pain. The whole family eats a special diet to minimize stomach acidity.
"GERD can affect the whole family, physically, financially and emotionally," McGraw says. "Raising awareness is not only going to help heal the child, which is so important, but it can help heal the whole family."
More information
To read more about GERD in children, visit the PAGER Web site, Reflux.org. Or check the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition Web sites at KidsAcidReflux.org or TeensAcidReflux.org.
