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Gastroesophageal Reflux Disease in Children With Disabilities
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Gastroesophageal Reflux Disease in Children With Disabilities

(GERD—Child With Disabilities; Chronic Heartburn—Child With Disabilities; Reflux Esophagitis—Child With Disabilities; Gastro-oesophageal Reflux Disease—Child With Disabilities; GORD—Child With Disabilities; Heartburn—Child With Disabilities; Reflux—Child With Disabilities)

Pronounced: Gas-tro-ee-sof-a-geal re-flux disease

En Español (Spanish Version)

Definition

Gastroesophageal reflux disease (GERD) is a disorder that results from food and stomach acid backing up into the esophagus from the stomach. GERD is different from gastroesophageal reflux (GER). GER is a common disorder seen in infants, which causes them to spit up. Most infants outgrow GER within 12 months.

Children who have congenital malformations (birth defects) or neurological impairments (disorders that affect the brain and spinal cord) are at an increased risk of GERD.

This condition can cause serious health issues. The sooner it is treated, the better the outcome.

Gastroesophageal Reflux Disease

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© 2008 Nucleus Medical Art, Inc.

Causes

The exact cause of GERD is often unknown. These factors may contribute to it:

  • Congenital malformations
  • Abnormal pressure to the lower esophageal sphincter (LES), a valve that keeps food in the stomach
  • Narrow or short esophagus
  • Delayed emptying of the stomach
  • Possibly a genetic link

Risk Factors

The following factors increase your child’s chance of developing GERD. If your child has any of these risk factors, tell the doctor:

Symptoms

If your child experiences any of these symptoms do not assume it is due to GERD. These symptoms may be caused by other, less serious health conditions. If your child experiences any one of them, see the doctor.

  • Difficulty swallowing or choking with feedings
  • Apnea or blue spells (called cyanosis), when not enough blood gets to the lungs
  • Refusal to eat
  • Increased mouth secretions
  • Regurgitation or vomiting
  • Bloody vomit
  • Weight loss or poor weight gain
  • Pain in the abdomen or chest
  • Recurrent pneumonia or respiratory problems
  • Coughing or wheezing
  • Hoarseness
  • Arching back while feeding
  • Irritability or restlessness while feeding

Diagnosis

Your doctor will ask about your child's symptoms and medical history, and perform a physical exam. Your child may need to see a pediatric gastroenterologist, a doctor who specializes in gastrointestinal diseases

Tests may include the following:

  • Swallowing evaluation—an occupational therapist will evaluate your child’s ability to swallow
  • Upper GI series —a series of x-rays of the upper digestive system taken after drinking a barium solution
  • Upper endoscopy with biopsy—a tube is inserted into esophagus to look at the lining and a piece of tissue is taken for testing
  • Upper endoscopy with biopsy—a tube is inserted into esophagus to look at the lining and a piece of tissue is taken for testing
  • 24-hour pH monitoring—a probe is placed in the esophagus to keep track of the level of acidity in the lower esophagus
  • Nuclear medicine scan—images are taken after a very small dose of radioactive material is swallowed or injected, used to evaluate how long it takes for the stomach to empty or to see if food or liquid is getting into the lungs (pulmonary aspiration)

Treatment

Treatment focuses on preventing injury to the esophagus, getting enough nutrition, and minimizing the risk of aspiration. This requires a team approach. For example, members of the medical team may include a pediatrician, pediatric gastroenterologist, nutritionist, surgeon, nurses, feeding specialist, physical therapist, and an occupational therapist.

Talk with your doctor about the best treatment plan for your child. Treatment options include:

Nutritional Management

Maintaining adequate nutrition is a crucial part of treatment. The doctor may recommend inserting a tube into your child’s stomach for feeding. A feeding tube ensures that the nutritional needs are being met, minimizes the risk of choking, and often eases the stress of feeding.

Medications

Your child’s doctor may prescribe medication to promote healing and relieve symptoms. Examples include:

  • Histamine-2 receptor drugs—to decrease acid production (eg, Tagamet, Pepcid, Zantac)
  • Proton pump inhibitors—to heal the esophagus lining and relieve symptoms (eg, Prilosec, Prevacid, Protonix, Nexium)

Many of these are available in liquid or powder form.

Surgery

In severe cases, the doctor may recommend surgery. The most common treatment is called fundoplication . During this procedure, the surgeon wraps part of the stomach around the lower esophageal sphincter. This makes the sphincter stronger and prevents stomach acid from backing up into the esophagus.

Prevention

While the cause of GERD is largely unknown, you can take steps to control the condition in your child by:

  • Keeping the medical team informed of changes in your child's health
  • Learning how to care and use the feeding tube
  • Keeping a diary of your child's symptoms and progress

RESOURCES:

Children’s Digestive Health and Nutrition Foundation
http://cdhnf.org/

National Digestive Diseases Information Clearinghouse
http://digestive.niddk.nih.gov/index.htm

CANADIAN RESOURCES:

About Kids Health
http://www.aboutkidshealth.ca

Canadian Digestive Health Foundation
http://www.cdhf.ca/index.html

References:

Dente K. Quick lesson about gastroesophageal reflux disease in children and adolescents. EBSCO Nursing Reference Center website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=16topicID=860 . Accessed May 19, 2008.

Gastroesophageal reflux in children and adolescents. National Digestive Diseases Information Clearinghouse website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/gerinchildren/index.htm . Accessed May 19, 2008.

Gastroesophageal reflux and gastroesophageal reflux disease in the neurologically impaired child. Children’s Digestive Health and Nutrition Foundation website. Available at: http://gerd.cdhnf.org/User/Docs/PDF/NERO_Brochure.pdf . Accessed May 21, 2008.

GERD in children with an underlying structural anomaly. Children’s Digestive Health and Nutrition Foundation website. Available at: http://gerd.cdhnf.org/User/Docs/PDF/CUSA_Brochure.pdf . Accessed May 19, 2008.

Pediatric gastroesophageal reflux, clinical practice guideline summary. Children’s Digestive Health and Nutrition Foundation website. Available at: http://gerd.cdhnf.org/User/Docs/PDF/GERD_8_pg_brochure_031604.pdf . Accessed May 19, 2008.

Pediatric GE reflux clinical practice guidelines. J Pediatr Gastroenterol Nutr. 2001;32:S1-S31.



Last reviewed May 2008 by Kari Kassir, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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