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Heartburn and GERD in Kids

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By Goutham Rao, MD

Do you think heartburn is just an adult problem? Think again. Though there are many unanswered questions about heartburn in kids, it’s gradually becoming clearer that many children suffer from heartburn. More than one-quarter of high school students, for example, report symptoms of reflux disease, including heartburn, at least once a month1. Heartburn in children may be just as severe as heartburn in adults, and associated with the same types of complications. Diagnosing heartburn in children is more difficult than in adults. In general, children have more trouble explaining their symptoms than adults. Ask a fifty-year-old if he has ever had heartburn and he most likely will understand what you mean. Children, by contrast, have difficulty describing symptoms of reflux disease, including heartburn and regurgitation.

Among children with reflux disease, recurring abdominal pain is the most common symptom. Pain that is worse around the upper part of the abdomen (as opposed to around the belly button) is typical of GERD. Next to abdominal pain, heartburn is the most common symptom of GERD in children, followed by respiratory symptoms (such as chronic cough), regurgitation, and chest pain2.

In addition to these common symptoms, certain risk factors make it more likely that a child has GERD. Up to 67% of all children have a history of reflux or “spitting up” at 4-5 months of age3. In most cases this resolves by the time a child is one year old. A history of recurrent vomiting in infancy, however, makes it more likely that an infant will develop GERD and associated heartburn later on in life4. A child with a family history of GERD and heartburn is more likely to suffer from heartburn himself 5. As among adults, excess weight is a risk factor for heartburn6. Exposure to secondhand tobacco smoke is also a risk factor for GERD in children7.

You should suspect that your child may have troublesome heartburn if he or she complains of frequent bouts of abdominal pain, especially in the upper abdomen, or describes heartburn in much the same way an adult might describe it, and has one or more of the risk factors described above.

Frequent heartburn (> twice per week) should be treated. As in adults, lifestyle changes are appropriate. These include avoiding fatty foods, caffeinated beverages of any type, chocolate and eating before naps or bedtime. Weight loss is important in overweight children with heartburn. These lifestyle changes may be enough to provide satisfactory symptom relief in some cases. However, it is important to treat heartburn that does not respond to lifestyle changes. Untreated heartburn can seriously affect a child’s quality of life. Treating heartburn, for example, can improve symptoms of asthma in some children. It has even been speculated that by interfering with food and activity choices, heartburn in children may lead to weight gain and obesity6.

Your health care provider has a number of medication options to consider when lifestyle changes alone are not enough. These include antacids, histamine-2 blocking drugs (such as ranitidine and famotidine), and the more powerful proton pump inhibitors (PPIs). You shouldn’t give your child any of these medications without first consulting your health care provider. He or she is best equipped to determine if your child is actually suffering from heartburn or another condition. Medications approved for treatment in children and children’s medication dosages are different than those for adults. Your health care provider can recommend or prescribe a medication regimen that is effective and safe for your child.

References:

  1. Ramesh P, Braden D, Dey S, Guasekaran TS. Prevalence of gastroesophageal reflux disease (GERD) symptoms in a Caucasian predominant adolescent population. Gastroenterology 2002;122: A213.
  2. Ashorn M, Ruuska T, Karikoski R, Laipala P. The natural course of gastroesophageal reflux disease in children. Scand J Gastroenterol 2002;37: 638-41.
  3. Nelson SP, Chen EH, Syniar GM, Christofel KK. Prevalence of gastroesophageal reflux during infancy: a prediatric practice-based survey. Pediatric Practice Research Group. Arch Pediatr Adolesc Med 1997;151: 569-72.
  4. El-Serag HB, Gilger M, Carter J, Genta RM, Rabeneck L. Childhood GERD is a risk factor for GERD in adolescents and young adults. Am J Gastroenterol 2004;100: 806-12.
  5. Trudgill N. Familial factors in the etiology of gastroesophageal reflux disease, Barrett’s esophagus, and esophageal adenocarcinoma. Chest Surg Clin N Am 2002;12: 15-24.
  6. Stordal K, Johannesdottir GB, Bentsen BS, Carlsen KCL, Sandvik L. Asthma and overweight are associated with symptoms of gastro-esophageal reflux. Acta Paediatrica 2006;95: 1197-1201.
  7. Hassall E. Decisions in diagnosing and managing chronic gastroesophageal reflux disease in children. J Pediatr 2005;146: S3-S12.