Heartburn / GERD in Infants and Children : Should You be Concerned?

Heartburn is a chronic digestive disorder which is marked by a painful burning sensation experienced just below the breastbone or the chest.

The pain is caused due to the abnormal reflux of acid from the stomach into the oesophagus which happens because the lower oesophageal sphincter (LES) muscle that protects the entrance of the stomach, relaxes, and gives way to the acid to flow back up.

This relaxation of the sphincter muscle is usually a result of poor diet and lifestyle.

Though heartburn is a relatively common disorder which can be easily treated by using simple medications and home remedies; its increased frequency and negligence can lead to a more complex ailment called Gastro Oesophageal Reflux Disease (GERD).

Heartburn/GERD in children and infants

Heartburn or gastro oesophageal reflux disease, though occurring at any age, is very common in infants and children.

This is the main reason of vomiting in newly born and usually is not very severe or problematic as in adults or in older children.

Everyone experiences reflux from time to time. Burping is also a result of the occasional relaxation of the LES that causes bad taste in mouth. However, the LES of infants is weak and may cause frequent refluxes leading to the foul taste in mouth almost all the time. 

Most of the times during infancy, the milk or formula food while being digested are refluxed up due to the weak LES which can’t hold the food down.

The reflux may be intense enough to cause vomiting or it may be in lesser intensities that cause the food to come only half way up, resulting in heartburns, suffocation, discomfort or no symptoms at all.

This is a common phenomenon during infancy and may occur frequently but such symptoms with unusual conditions or if frequently occurring in older children might reflect a need to seek immediate medical attention. 

Some other common reasons that might lead to acid reflux in infants and children include obesity or being overweight, exposure to second-hand smoke, eating certain types of foods such as chocolates, sweets, spicy food etc. and other physiological problems.

It has also been reported that children with cerebral palsy are more prone to develop acid reflux that others . 

Heartburn GERD in infants and children

Why you should be concerned about GERD in infants and children?

Though heartburn is common in infants, it might cause several complicated problems too if not taken care of.

Sometimes, the refluxed milk or acid might reach the wind pipe and lead to pneumonia, asthma or choking. Infants who vomit frequently may not gain weight while growing up because of the spilling out of all the nutrients before being absorbed in the intestines. 

Heartburn is definitely a bigger concern in case of older children because besides causing malnutrition, it may affect the gut by causing ulcers and inflammation.

The ulcers may be severe enough to bleed and lead to anaemia as well.

Frequent heartburn and GERD may cause similar complications as in adults such as strictures, Barrett’s oesophagus and even cancers quite easily because a child’s gut is not developed and protected enough to handle the acid attack as in the adults .  

There is a special condition in infants called pyloric stenosis in which the muscular ring between stomach and duodenum is closed too tightly that the food cannot pass down.

This way, it comes back up as projectile vomiting. In such a case, the child may not have GERD due to a problematic LES but the pylorus muscle.

This condition is characterized by too much vomiting after feeding and weight loss. It is generally treated by surgery after being diagnosed .

Looking for symptoms of heartburn in infants

Most infants so not show any symptoms of heartburn of GERD and usually the regurgitation of milk in infancy is normal.

In case of excessive reflux however, the food pipe of the infant may be affected just like in older children or adults causing inflammation.

In such a condition, the child may be hungry but will refrain from having any food or milk because the food may irritate the oesophagus causing pain.

The infant may be uncomfortable and refuse to take up bottle, spitting up the milk if taken in any case. Weight loss is also a major symptom that when combined with the abstaining of food clearly indicates the onset of GERD which might be deleterious and not the one which occurs normally in infants. 

Several other symptoms of acid reflux in newly born and older children are similar to those observed in adults such as asthma, wheezing, cough, hoarseness of voice, difficulty in swallowing and pneumonia.

Some children may become excessively irritable due to the discomfort caused by the disorder while some may have nonspecific symptoms such as arching of the back.

In any case, parents must look out for anything that is different from normal or unwanted and seek medical attention immediately . 

Home remedies for acid reflux in children

It is important for the parents to observe the symptoms in children and decide if the child is developing the symptoms of acid reflux or not.

In case the situations are in favour of development of heartburn like symptoms, it is best recommended that the feeding habits and lifestyle of the child be changed first.

In case of severe symptoms, it is always advised to rush for a doctor’s advice but to prevent any symptoms or to treat any minor appearances of the symptoms, simple feeding patterns can be transformed to see if they help reduce the problem of heartburns.

Add rice cereal to formula: adding two to three teaspoons of rice cereal to each ounce of milk formula helps thicken the food and makes it stay down instead of regurgitating back. 

Elevating the bed: as for the adults, elevating the head of the infant or the child always helps reduce symptoms of heartburn.

It is not advisable to use supporters for an infant or make the infant sleep on the left side (which works for adults) because newly born children are more prone to sudden infant death syndrome (SIDS).

Thus infants should always be made to sleep on the back with the head elevated a few inches.  

Holding the infants in upright position after feeding: it is always appropriate to hold the kid in the upright positing after feeding. This helps food to settle down and prevent regurgitation.

The baby should be held in this position or propped up in an infant seat for at least 15 to 20 minutes before lying them down. Also, they should never be bounced or jiggled up and down after feeding .

Avoid placing children on stomach: it is never a good idea to place the infant on stomach right after feeding. They should always be kept upright or on their backs to prevent acid reflux. 

Prescribed remedies

Some remedies for children may be prescribed by the doctor before trying on any medications. The purpose of these is to avoid the consumption of any synthetic drugs and treat the disorders in the preliminary levels with simpler remedies.

Add more calories to the feed: adding “prescribed” supplements to the breast milk or normal formula can help reduce heartburn by increasing the density of the calories in the food that makes it stay down in the stomach.

Care should be taken as to use such supplements only after a doctor’s prescription. 

Tube feedings: the excessive reflux conditions in some babies can make them too tired to feed. They may refuse to take milk or become irritable when sighting food.

In such cases, tube feedings are the best option where milk is fed with a tube that is inserted from the nose up till the stomach which prevents the contact of food with the inflamed food pipe, thus avoiding pain while feeding . 

If the child or an infant shows no improvement in symptoms of heartburn after following such small changes in the routine or feeding habits, or if the symptoms worsen, it is advisable to call a doctor immediately and seek for medical attention. 

Important precautions

Like heartburn in adults can be easily treated by over the counter medications such as antacids, proton pump inhibitors, H2 antagonists and other chemical or medicinal remedies, including herbal products; acid reflux issue in children is more sensitive and should not be risked.

It is always advised to stay away from any antacids, proton pump inhibitors, H2 antagonists or any other kind of over the counter drug to be given to a child or an infant without a doctor’s prescription. 

Only if a doctor recommends a medication, should the child be given the same to prevent any side effects or unwanted consequences.

It is also not sensible to try any kind of herbal remedies such as artichoke, milk thistle, slippery elm, fennel tea, chaparral, chamomile etc on children, especially infants.

The herbs may be useful for adults but may lead to severe medical consequences in case of newly born babies and children. If an infant is to be given anything, herbal or chemical, it should be after taking an advice form a medical practitioner . 

Summary

Heartburn, regurgitation and vomiting are common phenomena in newly born babies and in children up to a few years of age.

However if this happens in older children or in infants with symptoms like frequent regurgitation, difficulty in swallowing, refusal to take food and other uncommon signs, it might be a call for attention.

Preliminary symptoms of acid reflux in children and infants can be avoided by taking simple precautions and changing routine habits of feeding but if there is no recovery from the symptoms or if they get worse, immediate medical advice should be taken to avoid any unwanted consequences.