children s health issues
Gastroesophageal Reflux in Children
Treatment of Gastroesophageal Reflux
For spitting up in infants, parents may use thickened formula, special positioning, and frequent burping For breastfed infants, changing the mother's diet For formula-fed infants, a trial of a hypoallergenic formula Other measures to reduce reflux Sometimes medications Rarely surgery Treatment of reflux depends on the child’s age and symptoms. Forinfantswho just have mild spitting up when being burped, doctors reassure parents that there is nothing more serious happening. They may recommend no treatment or may suggest measures such as thickening formula for feedings, special positioning, and frequent burping. Formula can be thickened by adding 1 to 3 teaspoons of rice cereal per ounce of formula. The nipple may have to be cross-cut to allow the formula to flow. Infants with reflux should be fed in an upright or semi-upright position and then maintained in an upright, nonsitting position for 20 to 30 minutes after eating (sitting, as in an infant seat, increases stomach pressure and is not helpful). In addition, burping the infant after every 1 to 2 ounces can help decrease pressure in the stomach by expelling the air the infant swallows. Cow's milk allergy can occur even in breastfed infants and can cause GERD. Mothers can try not drinking cow's milk for several weeks and see whether it is helpful. Formula-fed infants may benefit from a 2- to -4-week trial of a hypoallergenic formula because they may have a food intolerance or allergy. Hypoallergenic formula can even be helpful for infants who do not have a food allergy because the formula helps the stomach empty faster. Because of safety concerns, doctors no longer recommend raising the head of the crib or bed. Doctors do recommend that infants should be put on their back to sleep. This position reduces the risk of Prevention . Older childrenalso should avoid eating 2 to 3 hours before bedtime, drinking carbonated beverages and those that containcaffeine, taking certain medications (such as those with anticholinergic effects), eating certain foods (such as chocolate or fatty foods), and overeating. All children should be kept away fromcaffeineand tobacco smoke. If changes in feeding and positioning do not control symptoms, doctors may prescribe medications. Several types of medications are available for reflux: Those that neutralize acid Those that suppress acid production Those that improve the movement of the digestive tract (promotility medications) Antacids are medications that neutralize stomach acid. These medications work quickly to relieve symptoms such as heartburn. Acid-suppressing medications may be required for children with more severe disease. By reducing stomach acid, these medications lessen symptoms and allow the esophagus to heal. There are two types of Treatment : histamine-2 (H2) blockers and proton pump inhibitors (PPIs). H2 blockers do not suppress acid production quite as much as PPIs. Promotility medications (such aserythromycinandbaclofen) may help increase the speed at which the stomach empties. Improved stomach emptying should decrease stomach pressure, making reflux less likely to occur. Acid-suppressing medications and promotility medications may help infants who have gastroparesis. Rarely, reflux does not go away after medications are tried and is so severe that doctors recommend surgery. The most common surgical procedure is a fundoplication. In fundoplication, the surgeon wraps the top of the stomach around the lower end of the esophagus to make that junction tighter and decrease reflux. Some anatomic causes of reflux, vomiting, or both also may have to be corrected surgically. 