Gastro-esophageal Reflux In Children
You think it’s heart-burn? Think again: Gastro-esophageal reflux in children – GER or GERD – is not your father’s reflux! The symptoms, and the risks, are completely different in children. YOU may have reflux and complain of heart-burn. But not your baby! And, severe reflux in infants and children can be life-threatening. So: DO you know the symptoms? Do you know what to look for? Let’s look at the numbers, then review the symptoms, and what to do about it if your little one is refluxing.
Here are some concerning statistics:
- It is estimated that more than 75 Million people in the U.S. struggle with reflux
- Reflux is on the rise, likely related to our growing epidemic of obesity
In CHILDREN, reflux symptoms are completely different from adults.
Because of that, children are mis-diagnosed, and under-diagnosed:
- In half of children ages 1-5 years with reflux, it takes more than 3 MONTHS to diagnose them
- 78% of these children visited multiple physicians before someone made the correct diagnosis!
So What Are The Signs and Symptoms of GERD in Children?
- “Spitting up” – a “spitty baby” has reflux!
- Colic – a “colicky baby” has reflux until proven otherwise!
More Worrisome Signs and Symptoms of Severe Reflux:
- Stridor (high-pitched breathing noises)
- Apnea (periods without breathing)
- Chronic cough – due to regular irritation of the airway
- Nighttime cough – due to reflux and choking
- Hoarseness – due to regular inflammation of the larynx by stomach acid
- Chronic rhinitis – due to gastric acid burning the back of the nose during sleep
- Recurrent croup – due to swelling of the upper trachea
- Laryngospasm – due to irritation of the larynx
- Subglottic stenosis – chronic swelling of the upper trachea
- Failure to thrive
What you don’t see on this list is complaint of heartburn!
That’s because children and infants who have reflux don’t experience heartburn. A few of them complain of a “tummy ache,” but in twenty years of caring for these children, I have never heard the complaint of heartburn.
The other thing you should notice from this list:
Nearly all of the signs and symptoms of severe reflux in children and infants are respiratory!
It’s Not Asthma
And what do you think the majority of these children are diagnosed with when they go to their pediatricians?
Number-one diagnosis: reactive airway, asthma!
And: The majority of these children will visit multiple physicians before someone makes a correct diagnosis.
In the meantime, these kids are being treated for something they don’t have! The confusing thing is that some of the treatments for asthma – steroid “puffers,” for example – will help reduce the inflammation of the airway that is being caused by reflux. That can help reduce the symptoms caused by the reflux, even though the underlying of the child’s symptoms is not asthma!
- child has reflux, with respiratory symptoms
- mis-diagnosed with asthma
- treated with inhaler
- symptoms improve
- diagnosis “confirmed”
Understandable then, why so many docs mis-diagnose these children.
Reflux Presents as Respiratory Symptoms in Children
A large study was reported in 1991 in the Journal of Pediatric Surgery (reference #1 below). They looked at 500 children with respiratory complaints, and they used pH monitoring as a measure of which kids had reflux. In the children with apnea (the ones who stopped breathing) and recurrent bronchopulmonary infections (bronchitis, pneumonia), 85% had moderate to severe reflux!! Of these, 83% improved by treating them with antireflux medications! NOT asthma medications! Impressive.
If you want to see what reflux looks like at the tissue-level in the esophagus, take a look at one of my early publications, from 1998: http://archotol.jamanetwork.com/article.aspx?articleid=219584 (free pdf).
So, if your little boogorhead has any of the symptoms listed above, and your pediatrician is telling you that it’s asthma or “reactive airway,” it’s time for another opinion. And maybe even another opinion after that, if necessary. Remember: nearly 80% of these kids see multiple physicians before someone makes the correct diagnosis. And, even though I have not focused on the scary stuff, severe GERD in children and infants can be fatal. So be persistent.
- Andze GO, Brandt ML, St Vil D, Bensoussan AL, Blanchard H (1991) Diagnosis and Treatment of gastroesophageal reflux in 500 children with respiratory symtoms: the value of pH monitoring. J Pediatr Surg 26: 295-299.
- Zalzal GH, Tran LP (2000) Reflux Symptoms in Infants and Children. Otolaryngol Clin North Am 33: 152-161.
- May JG, Shah P, Lemonnier L, Bhatti G, Koscica J, et al. (2011) Systematic Review of Endoscopie Airway Findings in Children With Gastroesophageal Reflux Disease. Ann Otol Rhinol Laryngol 120: 116-122.
- Faust RA (2003) An 18-month-old with progressive hoarseness. Pediatric Rounds. Hospital Physician, 39: 38-45.
- Faust RA (2003) Childhood voice disorders: Ambulatory evaluation and operative diagnosis. Clinical Pediatrics, 42: 1-9, 2003.
- Stroh BC, Faust RA, Rimell FL (1998) Results of Esophageal Biopsies Performed During Triple Endoscopy in the Pediatric Patient. Archives of Otolaryngology – Head and Neck Surgery, 124: 545-549.
Image Credit: photos above used under license from http://depositphotos.com/
Hi, I’m Russell Faust, author of this medical education blog.
That wonderful photo of me is by Chris Stranad; here is his site: http://www.chrisstranadphotography.com/Index.html
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