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JAMA Pediatrics Patient Page
October 2014

Gastroesophageal Reflux Disease

JAMA Pediatr. 2014;168(10):976. doi:10.1001/jamapediatrics.2013.3373

Many babies spit up during infancy, and occasional small spit-ups are normal. Spitting up is commonly described as the effortless spitting up of 1 to 2 mouthfuls of stomach contents. Spitting up is also called reflux, or gastroesophageal reflux.

The Mechanics of Reflux

The tube that connects the mouth to the stomach is called the esophagus. There is a valve at the top of the stomach that keeps food from going back up into the esophagus. If that valve is not fully developed, or opens at the wrong time, the stomach contents can move back, or “reflux,” into the esophagus.

Gastroesophageal Reflux in Babies

Reflux is usually seen in babies during or shortly after feedings. It occurs mainly in children younger than 1 year and typically begins in the first weeks of life. If your baby’s stomach is full or his or her position changes quickly, stomach contents can push up against the lower part of the esophagus and cause reflux. Gastroesophageal reflux rarely causes symptoms or distress and usually goes away as the baby’s digestive tract matures. It does not require treatment.

Symptoms of Gastroesophageal Reflux Disease

Occasionally, reflux can cause complications, in which case it is called gastroesophageal reflux disease (GERD). Gastroesophageal reflux disease occurs in less than 1% of babies and may include choking on spit-up milk, irritation of the esophagus, or poor weight gain. A baby with severe GERD may refuse to be fed or be irritable after feeding. An older child may complain of abdominal pain or describe symptoms that sound like heartburn such as pain or burning in the central chest area. If your child develops any of these symptoms, it is important to see your pediatrician.

Treatments for GERD

The first-line treatment for GERD is lifestyle changes. Babies who spit up often may benefit from being in an upright position or stroller for the first hour or so after feeding. Feeding smaller, more frequent amounts can also be helpful so long as your baby continues to gain weight. Children with GERD may benefit from avoiding fatty or fried foods. Other foods that have been associated with worsened GERD include peppermint, caffeine such as in soda, or tomato-based foods. If a food seems to worsen your child’s reflux or heartburn, keep it out of the diet for a week or 2 and then try it again. If symptoms come back with that food, it is best to avoid that food for a while. Medications are sometimes prescribed to treat GERD in infants and children, such as histamine 2 receptor agonists such as ranitidine. A recent review in this month’s JAMA Pediatrics suggests that evidence supporting the use of these medications is not strong and that further research on safety and effectiveness is needed.

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The JAMA Pediatrics Patient Page is a public service of JAMA Pediatrics. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your child’s medical condition, JAMA Pediatrics suggests that you consult your child’s physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 312/464-0776.
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Resource: American Academy of Pediatrics HealthyChildren.org