Reflux disease in children (gastroesophageal reflux)

Reflux means that the contents of the stomach appear in the esophagus. This is done by acid reflux or vomiting. All children vomit and spit to a certain extent but when it occurs more often than normal and negatively affects the child it is called reflux disease.

Gastroesophageal reflux disease is more common in children with congenital brain injury or developmental disorders, such as Down syndrome. It may also occur after an operation of a congenital malformation of the esophagus. In addition, reflux disease can be due to poorly developed motor skills or allergies to some type of food.

Why do children get reflux disease?

If the upper abdomen does not hold tightly, the contents of the stomach go up into the esophagus again. The upper gastric mouth is located between the esophagus and the gastric mouth and is usually not fully developed at birth. Instead, it develops fully during the child’s first year of life. It is difficult to determine what is normal and what can be classified as that the mouth has not yet developed since most young children can vomit after a meal. However, this does not adversely affect the child. But in some infants, the upper stomach is so immature that they vomit very often. These children can be adversely affected by it which can result in food refusal and therefore they do not gain weight as they should.

Symptoms of reflux disease

It is important to monitor the child’s vomiting without stressing it every time the child vomits. In most cases, this is perfectly normal. However, the reflux disease means that the child may not eat properly and that the child will lose or not gain weight properly. Vomiting can cause sore throat and some children may show signs that they want to eat but then stop and start screaming as it hurts to swallow. Reflux disease can also cause sleep disorders.

Diagnosis

A child with suspected reflux disease is often first tested for food allergies. Either the substances are excluded from the child’s own diet or from the mother’s diet if the child is still breastfeeding. If the problems disappear, it is not the cause of the reflux disease. However, if the symptoms persist, a further investigation is made. It is often possible to diagnose the disease only by means of its characteristic symptoms and based on a possible picture of the disease. If the doctor is unsure, a measurement is sometimes made of how often acidic stomach contents appear in the esophagus and how long it stays acidic. This is done with a thin tube that is placed in the esophagus and the measurement is performed for a day. The examination does not hurt and the child gets reassured in the meantime. At the same time, parents fill in a diary of sleep, meals and other activities. In more severe cases, ulcers can occur in the esophagus and the doctor can then make a diagnosis by looking down the esophagus with so-called gastroscopy.

Treatment of reflux disease in children

The first step is to ensure that the affected child receives regular and relatively frequent meals. They also try to give the child more viscous food as it does not come up easily in the esophagus. There is breast milk substitute that becomes viscous when it gets into the stomach but even moult can be mixed to a thicker texture. Medication that reduces the appearance of acid in the stomach is also a common treatment method. In very severe cases, an operation can be performed to improve the closure function of the mouth.

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