• A young baby between 4 and 8 months old has less than 4 wet diapers per day.
• An older baby between 8 months and 1 year old has less than 3 wet diapers per day.

• Signs of Dehydration:
• No tears when crying
• Dry mouth and tongue
• Sunken soft spot on the top of their head (fontanel)
• Sunken eyes with few tears
• Rapid heartbeat or breathing rate

• A child who is 4 months or older has less than 3 wet diapers per day or pees less than 3 times per day.

Helping Hands Patient Education Materials

Created by medical, nursing, and allied health professionals at Nationwide Children’s Hospital, Helping Hand instructions are designed to complement verbal guidance from a medical professional. The information is regularly updated to align with current practices. However, Nationwide Children’s Hospital is not liable for any outcomes resulting from the use or misuse of the information provided in the Helping Hands.

The esophagus serves as the channel for food moving from the mouth to the stomach. Reflux occurs when a child’s stomach contents flow back up into the esophagus, also known as gastroesophageal reflux (GER).

GERD stands for gastroesophageal reflux disease, a more severe and persistent form of reflux. If a child experiences reflux more than twice a week for a few weeks, it may indicate GERD.

What causes reflux and GERD in children?

A muscle called the lower esophageal sphincter acts as a valve between the esophagus and stomach. This muscle relaxes when a child swallows to allow food to pass into the stomach. Normally, this muscle remains closed to prevent stomach contents from regurgitating into the esophagus.

In children with reflux and GERD, this muscle weakens or relaxes inappropriately, allowing stomach contents to flow back into the esophagus. This can be caused by various factors, including:

• Hiatal hernia
• Increased abdominal pressure due to obesity or excess weight
• Medications like asthma drugs, antihistamines, sedatives, and antidepressants
• Prior surgery on the esophagus or upper abdomen
• Severe developmental delays
• Neurological conditions such as cerebral palsy

How common are reflux and GERD in children?

While occasional reflux is common in many children, GERD is less prevalent, affecting up to 25% of children with symptoms.

What are the symptoms of reflux and GERD in children?

Children may not always notice reflux symptoms, but some may taste food or stomach acid in their mouth.

GERD in children can lead to:

• Heartburn or painful swallowing, more common in older children aged 12 years and up
• Tooth erosion

How do doctors diagnose reflux and GERD in children?

Doctors typically diagnose reflux by evaluating a child’s symptoms and medical history. If symptoms persist despite lifestyle modifications and anti-reflux medications, further testing may be necessary to check for GERD or other issues.

Various tests can aid in diagnosing GERD, often requiring multiple tests for accuracy. Common diagnostic methods include:

• Upper GI series: Examines the upper gastrointestinal tract by having the child consume a contrast liquid and taking x-rays to track its movement through the esophagus and stomach.
• Esophageal pH and impedance monitoring: Measures acid levels in the esophagus using a tube inserted through the nose into the stomach, connected to a monitor recording acid reflux episodes over 24 hours.
• Upper gastrointestinal (GI) endoscopy and biopsy: Utilizes an endoscope to visualize the esophagus, stomach, and first part of the small intestine, sometimes including tissue samples for further analysis.

What lifestyle changes can help treat my child’s reflux or GERD?

Lifestyle changes can often manage reflux and GERD in children, including:

• Weight loss if needed
• Eating smaller meals
• Avoiding fatty foods
• Wearing loose clothing around the abdomen
• Maintaining an upright position for 3 hours after meals
• Sleeping at an incline by elevating the head of the bed

What treatments might the doctor give for my child’s GERD?

If lifestyle adjustments are insufficient, doctors may recommend medications to treat GERD in children by reducing stomach acid production.

Treatment options include over-the-counter and prescription medications such as antacids, H2 blockers, proton pump inhibitors, and prokinetics. Surgical intervention may be considered for severe cases unresponsive to other treatments, performed by a pediatric gastroenterologist.

Acid reflux in children, caused by a weakened esophageal muscle allowing stomach acid to regurgitate, can result in heartburn. Chronic acid reflux leading to esophageal damage is known as gastroesophageal reflux disease (GERD).

Remarkable care for kids

• Practical Solutions: Rush healthcare providers specialize in addressing GERD-related issues in children, offering personalized care and guidance for a healthier lifestyle.
• Family-Centered Approach: Pediatric gastroenterologists at Rush University Children’s Hospital involve families in developing customized care plans tailored to the child’s needs and habits.
• Healthier Lifestyle Habits: Nutrition experts at the Rush Nutrition and Wellness Center support families in achieving weight and nutritional objectives.
• Convenient Care: Pediatric gastroenterologists serve patients at multiple Rush medical facilities.

What is GERD?

While many infants outgrow acid reflux as their digestive system matures, older children can develop GERD, especially if they had reflux in infancy. Factors contributing to GERD in older children include medications, weight issues, smoking, and genetic predisposition.

GERD, or gastroesophageal reflux disease, is a chronic condition where stomach acid flows back into the esophagus, causing irritation and inflammation. Symptoms of GERD in older children may include heartburn, regurgitation, chest pain, difficulty swallowing, and persistent cough. If left untreated, GERD can lead to complications such as esophagitis, strictures, and Barrett’s esophagus.

Diet and lifestyle changes are often recommended to manage GERD in children, such as avoiding trigger foods, eating smaller meals, and not lying down immediately after eating. Medications like proton pump inhibitors or H2 blockers may also be prescribed to reduce stomach acid production.

It is important to note that GERD in children can be misdiagnosed as other conditions such as asthma, recurrent pneumonia, or chronic cough. If your child is experiencing any of the symptoms mentioned above, it is crucial to seek medical attention to properly diagnose and treat GERD.

In addition to medication, lifestyle changes such as diet modification, smaller and more frequent feedings, and keeping your child upright after meals can help manage GERD symptoms. Avoiding trigger foods such as spicy or acidic foods, caffeine, and carbonated beverages can also help reduce symptoms.

Remember that every child is different, and what works for one child may not work for another. Working closely with your child’s healthcare provider can help determine the best treatment plan for your child’s individual needs.

Care for GERD in children at Rush

Treatment for a child’s GERD may involve dietary adjustments, lifestyle modifications like weight management, medication changes, or even surgery in extreme cases. A multidisciplinary healthcare team may oversee your child’s treatment plan based on their condition.

Specialists involved in your child’s care may include:

GERD (gastroesophageal reflux disease) is a chronic digestive condition where stomach contents flow back into the esophagus, leading to symptoms or complications.

GERD represents a severe and enduring version of gastroesophageal reflux (GER).

Causes of GERD

Gastroesophageal reflux (GER) is prevalent among infants below 2 years old and kids aged 2 to 19 years. Most infants outgrow this condition between 12 and 18 months old. On the other hand, GERD, which is a more serious form of GER, can result in feeding difficulties and typically emerges after the age of 18 months. The main cause of GERD is often linked to dysfunction in the lower esophageal sphincter (LES), allowing stomach acid to flow back into the esophagus.

Some other factors that can contribute to the development of GERD include obesity, hiatal hernia, pregnancy, smoking, and certain medications. Certain foods and drinks, such as spicy foods, citrus fruits, caffeinated beverages, and alcohol, can also trigger or worsen symptoms of GERD.

Additionally, lifestyle factors like eating large meals, lying down after eating, and wearing tight clothing around the waist can increase the risk of developing GERD. Stress and lack of sleep can also play a role in exacerbating symptoms of this condition.

Risk Factors for GER and GERD

Neuromuscular disorders like muscular dystrophy can heighten the likelihood of developing GERD. Symptoms of GERD in children might necessitate multiple tests such as X-rays, endoscopy, and esophageal manometry for accurate diagnosis.

Treatment Options

Managing GERD

To alleviate GERD symptoms, adjustments in diet and lifestyle are crucial. Practicing appropriate feeding habits, consuming smaller meal portions, and avoiding trigger foods are effective measures. Additionally, managing weight and timing meals before bedtime can help control symptoms.

Additional Treatment

Physicians may prescribe medications like H2-blockers and proton pump inhibitors to reduce stomach acid production. They may also recommend adding rice cereal to formula or altering the feeding method for infants experiencing severe reflux.

Special Considerations

In severe cases, tube feedings may be vital for infants with other underlying health conditions that contribute to feeding challenges.