Explaining GER and GERD

ASK THE PEDIATRICIAN

What you need to know about gastroesophageal reflux and gastroesophageal reflux disease in children

By ANTHONY PORTO, MD, MPH, FAAP

American Academy of Pediatrics (TNS) A ll babies spit up – and it often seems like everything they just ate comes right back up! So, how do you know if your spitty baby’s symptoms are normal or part of a larger problem?

Without getting too technical, spit-up – also called reflux, gastroesophageal reflux or GER – is the movement of stomach contents into the esophagus, and sometimes through the mouth and nose.

When reflux is associated with other symptoms, or if it lasts beyond infancy, it is considered a disease known as gastroesophageal reflux disease or GERD.

GER in infants is not considered a disease. In fact, it is considered normal. These infants are known as “happy spitters” because they are not cranky and do not appear to be in much pain when spitting up. Your baby may actually feel better after a good spit-up.

Other symptoms of GER include mild feeding problems, such as occasional prolonged feeds or interrupted feeds.

GER usually begins at about 2 to 3 weeks of age and peaks between 4 to 5 months old. For most babies born full-term, symptoms go away by the time they are 9 to 12 months old; GER disappears as upper digestive tract function matures. Normal development – including improved head control and being able to sit up, as well as the introduction of solid food – also helps improve GER symptoms.

Babies may spit up if their stomach is full or their position is changed abruptly, especially after a feeding. The stomach contents – food mixed with stomach acid – press against the valve at the top of the stomach called the lower esophageal sphincter. This ring of muscle normally relaxes to let food pass from the esophagus into the stomach and then tightens again to keep the food there.

When it is not fully developed or opens at the wrong time, the stomach contents move back or “reflux” into the esophagus.

Unlike GER, GERD is associated with complications from acid reflux. Signs that it’s time to contact your child’s pediatrician include a refusal to feed, crying and/or arching their back during feeds like they seem to be in pain, blood or greenish color in the spit-up, increased frequency or intensity of the spit-up, a swollen belly, and respiratory symptoms.

Also be sure to let your pediatrician know if you notice that your baby doesn’t seem to be gaining weight or is having fewer wet and dirty diapers. These may be signs that not enough of what they eat is staying down.

The AAP believes it is important for all pediatric health care providers to be able to properly identify and treat children with reflux symptoms and to tell GER apart from more worrisome disorders. This can avoid unnecessary treatments and costs.

Your child’s pediatrician will review your child’s symptoms and feeding patterns. They will also assess their growth by plotting their weight and height on a growth chart. This information will help them determine whether your child is a “happy spitter” or has symptoms of GERD.

We wish we had a “quick fix” for babies who spit up. The truth is that for a good many spitty babies, it is mostly a matter of time. Lifestyle changes – including feeding and/or position changes – are recommended as first-line therapy for both GER and GERD.

If GERD is severe, treatment may include medication or surgery. Medications can reduce or neutralize stomach acid to treat symptoms.

Non-medicinal ways to stave off GER include burping at natural pauses in feeding in an upright position, keeping the baby upright for half an hour after feeding, and smaller more frequent feedings.

If your bottle-fed baby spits up unusually often, your pediatrician may recommend thickening their formula with a very small amount of baby cereal. Never add solids to the bottle unless your pediatrician advises it.

Since milk allergies can cause symptoms similar to GER or GERD, your pediatrician might suggest trying a dairy-free diet if you’re breastfeeding. For formula-fed babies, they may recommend switching to a special formula. These formulas either have proteins broken down into very small parts or are made from amino acids.

Your pediatrician may refer your child to see a pediatric gastroenterologist, a pediatrician who has specialized training in problems of the gastrointestinal tract – including GERD – for a variety of reasons. These include poor weight gain, feeding problems and a lack of response to medical therapy.

A pediatric gastroenterologist will review your child’s history, examine them and review their diet history and growth charts. Sometimes, it can be helpful for a pediatric gastroenterologist to observe your child being fed or self-feeding. Based on the visit, the doctor will decide whether your child may benefit from additional testing or from the addition of or a change in medications.

Anthony Porto, MD, MPH, FAAP is a board-certified pediatrician and board-certified pediatric gastroenterologist. He is an Associate Professor of Pediatrics and Associate Chief of Pediatric Gastroenterology at Yale University and Medical Director, Pediatrics, at Greenwich Hospital in Greenwich, Conn. Follow him on Instagram @Pediatriciansguide.

Without getting too technical, spit-up – also called reflux, gastroesophageal reflux or GER – is the movement of stomach contents into the esophagus, and sometimes through the mouth and nose.

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