By Christine Cardellino

If you have a colicky infant or if your firstgrader seems to be struggling with asthma, take a closer look at your child’s symptoms. They just might be warning signs of gastric reflux, one of the most common and treatable pediatric digestive disorders.

“Reflux should be considered in infants and children with frequent regurgitation or vomiting, pain in the upper mid-abdomen or mid-chest, difficulty swallowing solid food, coughing or wheezing that worsens during sleep, recurrent sore throats and weight loss,” says David F. Martin, M.D., a board certified internist and gastroenterologist with Pinehurst Medical Clinic.

“The respiratory symptoms—coughing and wheezing—may be confused with asthma. Actually, asthma and the medicines used to treat it make reflux worse, and reflux makes asthma worse. They often occur together.”

According to Dr. Martin, half of all infants between birth and 3 months of age, and two-thirds of 4- to 6-month-olds vomit at least once a day. The prevalence of vomiting decreases dramatically after 8 months of age and especially by age 2.

Gracie Scarboro, shown with Mom Christy, was
spitting up after each feeding almost from the time
her parents took her home from the hospital.

“A lot of what we used to call colic actually is heartburn, or acid indigestion,” adds Christoph Diasio, M.D., a board certified pediatrician with Sandhills Pediatrics. “Although many infants spit up after eating, if your baby is grumpy or fussy after feeding and having trouble gaining weight, or if there is blood in the vomit or stool, you should consult your family’s health care provider.”

That’s just what West End resident Christy Scarboro did during her daughter’s two-month checkup with Dr. Diasio.

“My daughter was spitting up excessively and was real fussy after eating,” Scarboro says. “She was spitting up after each feeding almost from the day we brought her home.”

A common cause
For infants and younger children with gastric reflux, a loose lower esophageal sphincter often is to blame. The lower esophageal sphincter is a muscle between the esophagus and stomach. During digestion, if this muscle relaxes too long or too often, acidic digestive juices can backflow into the esophagus, causing heartburn, spitting up or vomiting.

In older kids, genetic, environmental and dietary factors can trigger reflux. Your child may complain of pain after eating, upper-abdominal pain or acid indigestion.

“If mom and dad have reflux, their children are more likely to have it,” Dr. Diasio says. “Kids who are overweight or obese and those who are exposed to second-hand smoke are more prone to suffer from reflux. And a diet high in fatty and acidic foods, caffeine, chocolate and even peppermint can produce acid reflux, as can eating too close to bedtime.”

According to clinical guidelines from the North American Society for Pediatric Gastroenterology and Nutrition, a simple physical examination and a medical history are the most reliable and widely used methods of diagnosing reflux in young patients. Sometimes, barium contrast radiography, also known as an upper GI series, is performed to detect anatomical problems or blockages in the esophagus. This procedure uses X-ray technology to provide highly detailed images of the esophagus and stomach.

Before the procedure, the patient swallows a special solution that makes its way into the digestive track, enhancing visibility of the areas to be X-rayed.

Another medical procedure, esophageal pH monitoring, may be used in children with persistent
reflux that does not respond to treatment. Doctors insert a small catheter through the child’s nose, down the throat into the esophagus, stopping just above the lower esophageal sphincter. The catheter is equipped with a special sensor on the end. The sensor automatically records acid reflux activity for 24 hours and then is removed.

“A pH test measures how much acid or fluid reflux is occurring, and if a diary is kept of thechild’s symptoms, they can be compared to the timing of reflux events,” says Dr. Martin.

After diagnosing her with reflux when she was just 2
months old, her pediatrician prescribed medication
that has since controlled the problem.

Easily treatable
Doctors most often treat gastric reflux in children and infants with prescription or overthe-counter anti-acid medications.

Christoph Diasio, M.D.

“Some of the latest treatment advances include new classes of medication for acid indigestion and gastric reflux,” says Dr. Diasio. “Proton-pump inhibitors, for example, block pumps in the cells of the stomach lining where acid is produced.”

Another class of medications, H2-receptor antagonists, decreases acid production by cells in the stomach. Common brand names include Zantac (ranitidine hydrochloride) and Pepcid AC, an over-the-counter option.

For Christy Scarboro’s daughter, Dr. Diasio recommended Prilosec (omeprazole), which significantly reduced the infant’s symptoms.

“She’s doing very well now,” says Scarboro, who also suffers from reflux, as does her husband. “At our four-month checkup, Dr. Diasio was considering an increase in her dose, but she doesn’t need it. She hardly spits up anymore, and she’s definitely less fussy.”

David F. Martin, M.D.

In addition to medication, Dr. Martin recommends a common-sense approach.

“Parents who suspect reflux in their children can try lifestyle modification,” he says. “Eat less, reduce the amount of foods that weaken the lower esophageal sphincter and try to sleep on the left side. Elevating the head of the bed four to six inches on blocks may help as well.”

Other causes for concern
Although gastric reflux is a common culprit in children’s gastrointestinal troubles, the cause of symptoms is sometimes more serious.

“In older children, especially, I see irritable bowel syndrome, Crohn’s disease and celiac disease,” says Masoud Ahdieh, M.D., a pediatrician affiliated with FirstHealth Richmond Memorial Hospital. “These disorders are rare, but they do happen occasionally.”

Irritable bowel syndrome is common in children, adolescents and adults with overly sensitive intestines. Food, gas and even stress can cause intestinal spasms, which produce abdominal pain, diarrhea or constipation.

Masoud Ahdieh, M.D.

Crohn’s disease is a chronic inflammation of the digestive tract, most frequently the large or small intestine. Diarrhea and abdominal pain are two of the most common symptoms.

Celiac disease affects the small intestine and occurs in people who cannot tolerate gluten, a wheat protein. In addition to diarrhea and abdominal pain, irritability is a common symptom of celiac disease in children.

“Because symptoms of these disorders are similar to each other and to other gastrointestinal problems, parents should beware of unusual changes in their child’s bowel habits, patterns of constipation and/or diarrhea, or unexplained weight loss,” Dr. Ahdieh says.

“The most common thing I see children for is abdominal pain,” says Dr. Martin. “Reflux and constipation are probably the most common causes. Constipation is usually due to not eating enough fruits and vegetables, but sometimes milk constipates kids or gives them diarrhea.”

Dr. Martin urges parents to give their children fruit and vegetables at every meal.

“Most people—children and adults—don’t eat anywhere near the amount of vegetables and fruits they should, and obesity in children is becoming epidemic,” he says. “It causes diabetes, high blood pressure and elevated cholesterol, which can cause heart disease and strokes. High-fat foods, such as French fries and chicken tenders, are major risk factors for many types of cancer. Quit buying the snack foods. Give fruits and vegetables as snacks. And remember, macaroni and cheese is not a vegetable.”

“Parents definitely should watch their children’s diet and nutrition,” says Dr. Ahdieh, “A proper diet is very important for a healthy person and also a healthy gastrointestinal system.”