Reflux Problems Not Limited to Adults
Babies and children can also suffer from severe gastric distress, experts say
TUESDAY, Nov. 6, 2007 (HealthDay News) -- GERD can strike even the youngest person. Just ask Priscilla Dunstan.
When her newborn son screamed all day and night, relaxing only when she carried him upright in her arms, his doctor told her he had colic, a common condition among infants that tends to disappear by the age of 18 months.
But her baby didn't get better, because, as it turned out, he suffered from a more serious gastric condition that plagues adults, known as gastroesophageal reflux disease (GERD).
"He kept on crying going into the four-month period. He was screaming all the time," said Dunstan, who lives in Balmain, Australia, a suburb of Sydney.
Gastroesophageal reflux (GER) is a normal physiologic process that can occur throughout the day in healthy infants and children. Most episodes are brief and are typically confined to the lower esophagus, explained Dr. Aeri Moon, an assistant professor of pediatrics at Weill Cornell Medical College in New York City.
However, GER can worsen and become GERD when the stomach's contents move into the upper esophagus. While its prevalence has been noted among adults in recent years, GERD is frequently overlooked in youngsters, despite the fact that it affects as many as 7 million children, according to the Pediatric/Adolescent Gastroesophageal Reflux Association.
"GERD is a serious problem. It's a big deal," said Moon, who treats children with the disease.
Moon and Dunstan spoke recently in New York City at the launch of the Voices of GERD program, in an effort to bring attention to the problem of pediatric GERD.
Almost half of babies under 3 months of age will have GERD-like symptoms, which include spitting up and gas. Often the condition can be confused with colic, Moon said, but these symptoms usually subside between the ages of 15 months and 18 months. During this time, as long as the baby is gaining weight and is happy and sleeping, parents needn't be alarmed.
"However, if your baby doesn't outgrow vomiting, or if he or she has begun to associate eating and pain and is starting is develop eating disorders," Moon said, it is time to seek a pediatrician's help to see if your child is suffering from GERD.
Other possible GERD symptoms in young children include irritability, excessive crying, poor sleep patterns, coughing, sore throat or even pneumonia.
Between 50 percent and 80 percent of GERD cases are caused by the relaxation of the lower esophageal sphincter (LES), which separates the esophagus from the stomach and stays closed, except when someone swallows or burps. No one knows exactly why this muscle loses resiliency, allowing the acidic contents of the stomach into the upper esophagus, but coughing, having a lot of food in the stomach, pressure on the abdomen when trying to ease constipation, or obesity can all be contributing factors, Moon said.
Diagnosing GERD first involves eliminating other conditions with similar symptoms, such as testing for milk or food allergies, colic or inflammation of the esophagus, and finding out if there is a family history of GERD. Further tests include screening of the esophagus and a test that measures acidity in the esophagus.
If a young child has GERD, therapy includes introducing a dairy-free diet and/or a hypoallergenic baby formula. Overfeeding can also exacerbate the condition.
In older children, pediatricians recommend modifying the diet to avoid foods that trigger GERD symptoms. These include citrus drinks, chocolate, tomato-based foods, caffeine, spicy foods and peppermint. A child should also not lie down directly after eating.
There are also medications that can help control the disease, because they inhibit the production of acids, Moon said. In rare cases, surgery that wraps the top of the stomach around the esophagus to strengthen the lower esophageal sphincter is recommended.
Dunstan's son, now 9, has controlled his GERD through a careful diet, she said. He avoids dairy products and spicy foods, and, fortunately, doesn't like tomatoes.
In her exhaustive efforts to find out what was causing her baby so much pain, Dunstan, an accomplished musician and opera singer with a photographic memory for sound, was able to identify patterns in her son's crying that led her to link his screaming to his eating habits and to uncover his gastric problems.
That led to more research on her part and to her discovery of what she claims are the five initial sounds that young children make before beginning to cry hysterically. Distinguishing these sounds allows a parent to anticipate the baby's needs, which both helps a troubled child and dramatically improves the bonding between a parent and child, Dunstan claims.
The Pediatric/Adolescent Gastroesophageal Reflux Association explains more about pediatric GERD.