Of
all the gastroenterological disorders encountered
in infancy, acid reflux is, perhaps, the most
common. It is primarily due to the immaturity of
the lower esophageal sphincter (LES) function
manifested as frequent transient LES relaxations
causing the gastric contents to be regurgitated
into the esophagus. Thus, it is a common
physiological phenomenon in the first year of
life. If growth and development is normal and
medical intervention is not indicated. However,
pathologic acid reflux in children
is generally determined not merely by the number
and severity of reflux episodes but also by the
presence of reflux-related complications such as
failure to thrive, erosive esophagitis, esophageal
stricture formation, chronic respiratory disease
etc.
In
older children, the causes of acid reflux are the
same as those seen in adults. Anything that causes
the LES to relax or anything that reduces the
pressure below the LES can cause acid reflux. They
include obesity, overeating, certain foods,
beverages and medications.
The
symptoms of acid reflux in children
are masked or are similar to those from other
conditions. They may be as
follows:
1) Abdominal pain above the
belly button.
2)
Burning sensation in the esophagus.
3)
Refusing
food or eating only a few bites despite
hunger.
4)
Gagging
or choking.
5)
Poor weight gain or weight loss.
6)
Bad breath.
7)
Constantly runny nose and frequent sore
throat.
8)
Sinus infections and respiratory problems
(such as bronchitis, wheezing, asthma).
9)
Nighttime cough.
10)
Poor sleep, frequent waking.
11)
Frequent ear infections and/or ear
congestion.
12)
Excessive
salivation or drooling.
If acid reflux is
diagnosed in children, the doctor will most likely
recommend lifestyle changes first. Some lifestyle
changes which work are:
1.
Elevate the head of the child's bed using bricks
or blocks. This will not only lower the pressure
on the LES but also ensure a good night’s
sleep which in itself will reduce stress and
increase the well-being of the child. A wedge pillow is
also useful.
2. Keep the child upright for
at least two hours after eating.
3. Serve several small meals
throughout the day, rather than three large meals.
4. Limit foods and beverages
that seem to worsen the child's reflux. These
include mainly fried, high-sugar, and spicy foods
as well as carbonated beverages and chocolates.
5. Limit watching television
and encourage the child to get regular exercise.
6. Avoid
non-steroidal and aspirin-containing
medications.
Only
if these lifestyle modifications do not work, then
medications are considered. Most medications
suitable for adults may be prescribed, especially
proton pump inhibitors. With any childhood
condition, lifestyle changes are always considered
first because a child should live as normal and
medication-free a life as possible. Even in
children, acid reflux is a complicated
disease process with varying causes and symptoms.
Just treating the symptoms defeats the aim of
therapy. A holistic approach therefore will not
only relieve symptoms but also prevent
recurrences.
