What is Reflux?
What is Reflux? Most adults are aware that chest pain can be serious. There are lots of different causes of chest pain and some of these include:
- Trauma related to a direct blow to the chest
- A possible collapsed lung, called a pneumothorax
- The development of blood clots in the lungs, called pulmonary emboli
- Musculoskeletal chest pain, which can occur due to chest soreness following a coughing spell
- A heart attack, called a myocardial infarction, which stems from blood clots in the lungs
- Gastroesophageal Reflux Disease (GERD), often shortened to reflux
When a child complains of chest pain, many of these issues are overlooked. While the television commercials often fill the airways with images of elderly individuals suffering from heartburn, children can suffer from reflux as well. Why does this happen? What are the symptoms? What are the treatment options?
The Pathophysiology of Gastroesophageal Reflux Disease
Gastroesophageal Reflux Disease (GERD) is a relatively common problem in people of all ages. The stomach is home to an acidic solution full of digestive enzymes. These enzymes are responsible for helping to break down the food that people consume. Stomach acid is produced through multiple pathways and, sometimes, can leave the stomach and splash the lower esophagus. There is a sphincter that separates the esophagus from the stomach. This sphincter is supposed to prevent this reflux from happening. In some people, particularly babies, the sphincter is too loose. This allows stomach acid to splash the lower esophagus, causing the heartburn that so many people are familiar with. How does GERD present in babies and children?
An Overview of the Symptoms
There are lots of different symptoms that might indicate that someone is suffering from reflux. These symptoms change depending on the age of the individual. In babies, some of the symptoms include:
- Constant spits after age-appropriate feeds
- Continual burping and issues with gas
- Failure to gain weight between doctors’ visits
In older children, the symptoms might include:
- Complaints of chest pain in the middle of the sternum
- Pain that gets worse immediately after eating
- Excess burping following meals
First, these symptoms could vary from individual to individual. Like other diseases, the symptoms may also vary in severity from person to person. If reflux goes untreated, there could be serious complications. In babies, this could mean a failure to gain weight. Furthermore, malnourished babies could start to miss developmental milestones. Finally, in older children, teenagers, and adults, untreated reflux could lead to esophageal cancer. The continual splashing of stomach acid on the cells of the lower esophagus could lead to something called Barrett’s Esophagus, a precursor of cancer.
Treatment Options for Children with Reflux
For those who suffer from reflux, there are several different treatment options. These include:
Positioning: Particularly in babies, but also in other children, positioning matters. First, make sure that the baby is upright while eating. Next, try to take small breaks and burp every half-ounce to an ounce. Finally, keep the baby upright for about a half hour after eating. This will help the food settle in the stomach and prevent reflux. In older children, this translates to smaller, more frequent meals.
Food Choices: While most infant formulas are the same, older children could benefit from dietary changes. Try to avoid peppermint, tomatoes, citrus, chocolate, and other acidic foods. This could help relieve the chest pain caused by reflux.
Medications: There are medications that are available. These include antacids (such as Tums), H2 blockers (such as Zantac), and proton pump inhibitors (such as Prilosec). Be sure to discuss these medications with a trained physician because they do have their side effects.
Finally, for those with intractable reflux, there are also surgical options. The procedure is called a Nissen Fundoplication. In this procedure, the stomach is wrapped around the esophagus to tighten the esophageal sphincter. This makes it harder for stomach acid to leave the stomach and splash the esophagus.
Help from a Local Pediatrician
Whether it is a baby that constantly spits up or a child that won’t stop complaining of heartburn, this can frustrate parents. While reflux is known for causing heartburn, it can also lead to serious nutritional deficiencies. The risk is even more serious in babies who don’t have the caloric reserve of older children and adults.
Sometimes, the precautions discussed above are enough to keep the symptoms at bay. In other situations, medications or surgery could be required. The decisions are tough and parents should rely on the training and expertise of their local pediatrician. Because of this, do not hesitate to reach out and ask for help. Doctors are always willing to help families in need.
David Randolph, MD
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