Reflux in Children – Causes and Treatments

So, my last post discussed the role of reflux in asthma: Is Reflux Causing Your Child’s Asthma? Note that medical research shows that reflux plays a big role in rhinitis, sinusitis, and otitis also. This article discusses Reflux in Children: Causes and Treatments for Reflux.

What Causes Reflux in Children?

Let’s start the answer by saying “we don’t know”. The rest is mostly speculation, educated guessing. At the bottom of the esophagus (swallowing tube) there is a tightening of muscle where it enters the stomach (called the “lower esophageal sphincter”). This muscle is affected by many things. As you might imagine, anything that loosens that muscle will allow reflux to worsen. Some things that loosen that muscle include caffeine, alcohol, tobacco, mint teas, tight clothing (pressing on the stomach externally), lying down, and even obesity. Some medications also worsen reflux. Let’s assume that your infant isn’t smoking cigarettes, drinking alcohol or coffee. You can see that most of these factors should not be a problem for babies or children, although obesity is becoming more of a problem in children. The biggest factor for reflux in infants is position – they spend most of their time lying down.

What To Do About Reflux in Children?

General Considerations

  1. Manage stress. Stress and emotional turmoil will crank up the stomach acid, and have other negative effects. Too much can contribute to reflux, GERD. As always, to the best of your ability, provide your child with unconditional love, emotional support, and a safe and secure home environment.
  2. Consider an Elimination Diet protocol. Some specific foods or food groups may be causing reflux or respiratory symptoms (asthma, rhinitis, etc.). Eliminating your child’s symptoms may be as simple as getting rid of a food from their diet. This topic deserves a LONG post all by itself. Take a look at Dr. Jonega’s site (www.allergynutrition.com), take a look at her books (on my Amazon Store here), and search the web for “elimination diet”.
  3. Exercise. For children (adults too), make certain they are active. This will benefit their general health. It will help eliminate reflux. Get them up off the couch, pry them away from the video game and the TV, get them outside!!
  4. Supplement with a multi-vitamin that contains zinc. Zinc is necessary for a healthy GI tract.
  5. Consider using a probiotic for any child who is being treated for reflux (any treatment – conventional or alternative).

Infants

Simple things can help: after feeding try to keep them upright for awhile. If sleeping, try to place them on a slight incline, or prop up their bedding slightly under the head of the crib. Thickening their feedings can help them keep from refluxing. Rice cereal is a good thickener. For this to help, the formula or milk needs to be as thick as stage 1 baby food or tomato sauce (NOT paste!). Note that breast milk contains an enzyme that breaks down the cereal, so it will be good and thick to start, but thins out a few minutes later. You may want to thicken only an ounce at a time to prevent this from happening. Also note that thickened formula will not come out of a regular bottle nipple. Most bottle manufacturers have cross cut nipples and variable flow nipples. Ask your pharmacist to order some for you. Finally:  Not ALL reflux will be cured by thickening.

What Other Treatments Are Available?

For starters, “conventional” medicine uses something that is over-the-counter for adults (considered relatively safe):

Zantac(generic: Ranitidine)

I have had good results with this in my pediatric patients with  asthma, rhinitis, sinusitis, and otitis. It is a prescription for children. I use this mostly as a diagnostic technique: if I suspect reflux as a key factor in a child’s asthma, rhinitis, sinusitis, or otitis, I will place them on Ranitidine. If they clearly improve, we have our diagnosis. We then try to reduce the reflux without drugs. Keep reading …

Natural Alternatives to Drugs for Reflux in Children

Here are some “natural” alternatives to consider (see my previous article, A Few Words on Being Natural (http://wp.me/pR4iB-k5) for my thoughts on whether “natural” is always better):

DGL

In the 1940’s licorice was discovered to be effective in treating peptic ulcers. Unfortunately, side effects included high blood pressure, potassium loss, and fluid retention (just another example of “natural” not always being a universally positive remedy). Over time it was discovered that these side effects were caused by a chemical in licorice – glycyrrhizin. The solution is called “de-glycyrrhizinized licorice”, or DGL, where about 97% of the glycyrrhizin has been removed. Research has shown that DGL is a good anti-inflammatory. It has been effective against the esophagitis and other symptoms caused by GERD. How to use DGL? It usually comes as a chewy tablet, kind of like a gummy-bear. Chewing the tablet helps activate the DGL by mixing with saliva.

NOTE that safety information for DGL in children are not available. Dosing information is not available for children. Therefore, this option is only available for treating adult reflux. If you use DGL, store it out of reach of children – the gummy-bear resemblance to candy can be appealing to children.

Barley Grass

That’s a pic of barley grass above (credit, Matt Lavin). Barley grass consumption by humans dates back at least 7,000 years, and active cultivation of barley dates back to Mesopotamia, to about 2500 BC. Barley has amino acids and chlorophyll, and seems to contain effective anti-inflammatory ingredients. In addition, it has 11 times the calcium of cow’s milk, more than 4 times the iron from spinach, 7 times the Vitamin C of oranges, and is loaded with Vitamin B1. Sounds impressive. There has been very little scholarly research on the effects of Barley Grass in humans. It is used as an anti-inflammatory for reflux, similar to DGL. How to use Barley Grass? Dried barley grass is usually boiled and consumed as a tea, or mixed into water or juice.

Melatonin?

You’ve heard of Melatonin? Helps us sleep. This mostly speculation, but some integrative and holistic docs who are pretty smart speculate that our Melatonin also helps reduce reflux. How? Melatonin increases the muscle tone in the Lower Esophageal Sphincter. This might reduce upward flow of gastric contents. That is, increasing the tone in the LES might reduce reflux. Still speculation, but it makes sense that the natural hormone that helps us sleep would also help reduce reflux while we are lying down.

Histamine?

No – don’t give histamine to treat reflux. Reduce histamine to reduce reflux.

For my own reflux, Dr. Joneja’s histamine-restricted diet has made a huge difference! Check her site under Resources, below. It is a GREAT resource for those with food allergies, intolerance, and reflux. She has many free downloads. She has an amazing site! Check it out!

Quercetin

Quercetin is a bioflavonoid. It inhibits release of both histamine and leukotrienes. As a result, it is a strong anti-inflammatory, antioxidant agent. It occurs naturally in onions, garlic, and many dark-colored fruits and vegetables. Ask your pharmacist or naturopathic doctor (ND) about dosing for children. Even better, simply include natural sources in your child’s diet (in your diet too, while you’re at it). As a general principal, it is always better to get your nutrients directly from the source – your food.

Acupuncture

As good at managing reflux as powerful proton pump inhibitors (PPI’s) for difficult-to-treat reflux. I don’t use PPI’s in my patients. To find a Licensed Acupunturist near you, contact the American Academy of Medical Acupunture (see Resources, below).

Nutritional Supplements

There are studies suggesting that magnesium and other elements play a role in histamine release. Be certain that your little tyke has as well-rounded a diet as possible (see Littlestomaks.com for suggestions). The goal, of course, is for them to obtain all of their nutrients from a well-balanced diet. This is a huge challenge, especially in toddlers. Supplement with a good multi-vitamin to be sure. This simple step will help minimize reflux, and help keep them healthy in general. Be certain that the multi-vitamin includes Zinc. Nearly all of us are deficient in Zinc, and it helps the lining of the GI tract to heal, to repair itself. Ginger can have a “gastro-protective” effect – it protects the stomach. BUT: Caution should be taken when using ginger (Zingiber officinale), as some studies have found increased GI distress with high doses or prolonged use. So: if you have reflux, don’t over-do the ginger. Finally, ask your doctor – naturopath, pediatrician, or pediatric ENT. Check the website of the American Board of Integrative Holistic Medicine to locate an integrative healer near you: http://integrativeholisticdoctors.org/D/locate_physician.html

Surgery

As a LAST resort: For those children with life-threatening complications of reflux – failure to thrive, severe asthma, recurrent pneumonia from aspiration, etc. – and these other approaches just are not working – surgery may be a consideration. The most common and most successful is a procedure that tightens the lower esophageal sphincter, the muscle surrounding the esophagus where it enters the stomach. I do not personally perform this procedure, and can only say that some of my patients have experienced life-changing success from surgery to stop their reflux. Beyond that, ask your doc, search the web. . Reminder: the goal of these articles is to educate and inform. This is not medical advice. All treatment should be undertaken with the advice and guidance of a physician who has knowledge of your full medical history, your physical exam and any laboratory test details. See disclaimer: http://wp.me/PR4iB-r Future posts will examine the studies showing how reflux affects rhinitis and sinusitis, and what we can do about it. . I appreciate your comments and questions.  Keep ‘em coming.  Please, “be excellent to one another.” I invite you to subscribe (it’s FREE) to this blog for weekly updates – you won’t be swamped by updates, I simply cannot write for the blog everyday. Click here to subscribe for free weekly updates: (http://eepurl.com/FGnP) Type in your best email address (the one you actually use).  When the confirmation email from boogor doctor arrives, click on the link to give your okay to receive free weekly updates, occasional book or product reviews, without needing to visit the website. It’s free, it’s convenient. No ads. No spam. You can un-subscribe at any time.

Stay Informed.

Stay Healthy.

Best of health and success to you and your families. Until next time, remember … you can pick your friends, and you can pick your nose, but you can’t pick your friend’s nose (unless you’re a boogor doctor :~D)

Resources

American Academy of Medical Acupunture.  Tel: 323-938-5514. Website:  www.medicalacupuncture.org

Dr. Janice Joneja, PhD, RD (Registered Dietician): http://www.allergynutrition.com/

This is an outstanding resource for allergy and nutrition information, including food allergies and reflux.

I owe a great debt of gratitude to Dr. Robert Ivker for helping to eliminate chronic sinusitis and reflux from my life.

Of note, he is an original founder of the American Board of Integrative Holistic Medicine.

Image Credit: Image by Matt Lavin, Flickr:  http://www.flickr.com/photos/plant_diversity/

From this blog:

Is Reflux Causing Your Child’s Asthma? http://wp.me/pR4iB-uV

Things You Should Know About Asthma: http://wp.me/pR4iB-7k

A Few Words About “Being Natural”: http://wp.me/pR4iB-k5

Reflux and Otitis: Does GERD Cause Ear Infections? http://wp.me/pR4iB-fZ

Comments

  1. BriAnne says:

    Hi, my name is BriAnne and I’m so glad I found your website. My now ten month old son has been through the ringer as we’ve tried to find then cause of his chronic coughing, mostly at night. He has been put on breathing treatments of albuterol and pulmocort but neither really started making a very big difference until he started taking Zantac. Oh my goodness what a difference! Our pediatrician said to take him off, cold turkey, and see if his problems persist. They didn’t for about 2 months and now he is beginning to cough at night again. I have read about Xlear for infants and I was wondering what your thoughts are on it? Could it possibly help with reflux or mainly just allergies and asthma? Also, do you think trying melatonin would be a good next move before getting back on the Zantac? Would that be enough or do you usually recommend other supplements as well? Thank you for any advice you can give me!

    • Russell A. Faust, PhD, MD says:

      Hi BriAnne,
      So glad you found us!
      I don’t know of any data suggesting that either Xylitol or melatonin are helpful for reducing reflux. If you know of some, please let us all know here.
      In addition to this article above, please take a look at this one:
      http://www.boogordoctor.com/2012/05/herbal-remedies-for-reflux-gerd/
      But use caution: there are few, if any, clinical studies on the use of herbal remedies in children. My strong recommendation is to find a pediatrician that practices integrative, holistic medicine (that will be a challenge, depending on where home is for you), or to visit with a Doctor of Naturopathy (ND) who specializes in children.
      Thank you for sharing.
      And please: visit again and update me!

  2. HI Dr. Faust, my son suddenly started to have bubbles come up in his throat a couple of weeks ago. I can actually hear him burst the bubbles if I put my ear next to his mouth. He is burping constantly trying to clear these bubbles. My son also said that tomatoes burn his tongue. His doc is treating him with Prevacid and it has been about 6 days on a higher dose. He is hoping to rule reflux in or out. He said it could be eosinophilic esophagitis. (I hope not) Do the symptoms sound like reflux? My son has had 2 surgeries on his throat. So I was thinking that maybe there could be problems due to the surgeries.

    Thanks for any input, Carol

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