Gastroesophageal Reflux Disease or GERD is a quite common malady amongst infants, children, and teens. Not all reflux is GERD, not all vomiting is GERD, and not all GERD includes vomiting. Let us talk about infant GERD first.
First, all babies have some degree of reflux. Their lower esophageal sphincter is very loose. In lay terms, the valve that enters the stomach is leaky and it allows materials from the stomach to easily leak back up into the esophagus. Because of this infants frequently spit up. This is usually effortless and not forceful although it is not unusual to see “projectile” spit ups. The newborn does not produce enough acid to make this spit up uncomfortable and so it is considered normal. There are some notable exceptions. First the child who has uncomfortable spit-ups may arch their back, cry, or refuse to feed. These symptoms all need to be evaluated and you should call us if you have any of these concerns. Secondly, there are children who in the first 6-8 weeks of life recurrently projectile vomit. They do not reflux much during the first 2 weeks of life but progressively projectile vomit every feeding every time they eat. They eventually start to lose weight and may develop some electrolyte imbalances. This is a condition called pyloric stenosis. All infants with pyloric stenosis will projectile vomit, but not all projectile vomiting is pyloric stenosis. In lay terms pyloric stenosis is the valve that empties the stomach is too tight, thus the contents of the stomach cannot exit to the small intestine to be digested and the contents come up forcefully. This requires a surgical procedure that needs to be done by a pediatric surgeon. Diagnosis is done by pyloric ultrasound or a barium swallow study. We will admit the baby for IV fluids to correct any electrolyte deficiencies and transfer up to Children’s Hospital in Colorado Springs.
Treatment of GERD is symptomatic. We cannot “tighten” the lower esophageal sphincter with a medication. We are only able to make the contents of the stomach thicker by adding rice cereal to the formula (occasionally breast milk) or making the contents less acidic with either an H2-blocker (Pepcid) or a Proton-pump inhibitor (Prevacid). In general reflux improves after initiating solids after 6 months and continues to improve into the second year. We will discuss GERD in the child and adolescent in an upcoming blog.