Everyone has gastroesophageal reflux (GER), the backward movement (reflux) of gastric contents into the esophagus. Extraesophageal Reflux (EER) is the reflux of gastric contents from the stomach into the esophagus with further extension into the throat and other upper aerodigestive regions.<\/p>\n\n\n\n
In infants, more than 50 percent of children three months or younger have at least one episode of regurgitation a day. This rate peaks at 67 percent at age four months. But an infant\u2019s improved neuromuscular control and the ability to sit up will lead to a spontaneous resolute ion of significant GER in more than half of infants by age ten months and four out of five at age 18 months.<\/p>\n\n\n\n
Researchers have found that 10 percent of infants (younger than 12 months) with GER develop significant complications. The diseases associated with reflux are known collectively as Gastro-Esophageal Reflux Disease (GERD). Physically, GERD occurs when a muscular valve at the lower end of the esophagus malfunctions.<\/p>\n\n\n\n
Normally, this muscle closes to keep acid in the stomach and out of the esophagus. The continuous entry of acid or refluxed materials into areas outside the stomach can result in significant injury to those areas. It is estimated that some five to eight percent of adolescent children have GERD.<\/p>\n\n\n\n
Food or liquids that are swallowed travel through the esophagus and into the stomach where acids help digestion. Each end of the esophagus has a sphincter, a ring of muscle, that helps keep the acidic contents of the stomach in the stomach or out of the throat. When these rings of muscle do not work properly, you may get heartburn or gastroesophageal reflux (GER). Chronic GER is often diagnosed as gastroesophageal reflux disease, or GERD.<\/p>\n\n\n\n
Sometimes, acidic stomach contents will reflux all the way up the esophagus, past the ring of muscle at the top (upper esophageal sphincter or UES), and into the throat. When this happens, acidic material contacts the sensitive tissue at back of the throat and even the back of the nasal airway. This is known as laryngopharyngeal reflux or LPR.<\/p>\n\n\n\n
During the first year, infants frequently spit up, and in most infants, it is a normal occurrence that resolves in the first year. Only infants who have associated breathing or feeding problems require evaluation by a specialist. This is most critical when breathing-related symptoms are present.<\/p>\n\n\n\n
GER and EER in children often cause relatively few symptoms until a problem exists (GERD). The most common initial symptom of GERD is heartburn. Heartburn is more common in adults, whereas children have a harder time describing this sensation. They usually will complain of a stomach ache or chest discomfort, particularly after meals.<\/p>\n\n\n\n
More frequent or severe GER and EER can cause other problems in the stomach, esophagus, pharynx, larynx, lungs, sinuses, ears and even the teeth. Consequently, other typical symptoms could include crying\/irritability, poor appetite\/feeding and swallowing difficulties, failure to thrive\/weight loss, regurgitation (\u201cwet burps\u201d or outright vomiting), stomach aches (dyspepsia), abdominal\/chest pain (heartburn), sore throat, hoarseness, apnea, laryngeal and tracheal stenoses, asthma\/wheezing, chronic sinusitis, ear infections\/fluid, and dental caries. Effortless regurgitation is very suggestive of GER. However recurrent vomiting (which is not the same) does not necessarily mean a child has GER.<\/p>\n\n\n\n
Unlike infants, the adolescent child will not necessarily resolve GERD on his or her own. Accordingly, if your child displays the typical symptoms of GERD, a visit to a pediatrician is warranted. However, in some circumstances, the disorder may cause significant ear, nose, and throat disorders. When this occurs, an evaluation by an otolaryngologist is recommended.<\/p>\n\n\n\n
There are various symptoms of LPR. Adults may be able to identify LPR as a bitter taste in the back of the throat, more commonly in the morning upon awakening, and the sensation of a \u201clump\u201d or something \u201cstuck\u201d in the throat, which does not go away despite multiple swallowing attempts to clear the \u201clump.\u201d Some adults may also experience a burning sensation in the throat. A more uncommon symptom is difficulty breathing, which occurs because the acidic, refluxed material comes in contact with the voice box (larynx) and causes the vocal cords to close to prevent aspiration of the material into the windpipe (trachea). This is known as \u201claryngospasm.\u201d<\/p>\n\n\n\n
Infants and children are unable to describe sensations like adults can. Therefore, LPR is only successfully diagnosed if parents are suspicious and the child undergoes a full evaluation by a specialist, such as an otolaryngologist (ear-nose-throat doctor). Airway or breathing-related problems are the most commonly seen symptoms of LPR in infants and children and can be serious. If your infant or child experiences any of the following symptoms, timely evaluation is critical.<\/p>\n\n\n\n
In infants and children, chronic exposure of the laryngeal structures to acidic contents may cause long-term airway problems such as a narrowing of the area below the vocal cords (subglottic stenosis), hoarseness, and possibly eustachian tube dysfunction. The latter can cause recurrent ear infections, or persistent middle ear fluid, and even symptoms of sinusitis. The direct relationship between LPR and the latter mentioned problems are currently being researched.<\/p>\n\n\n\n
Most of the time, the physician can make a GERD diagnosis by interviewing the caregiver and examining the child. There are occasions when testing is recommended. The tests that are most commonly used to diagnose gastroesophageal reflux include:<\/p>\n\n\n\n
Fiberoptic Laryngoscopy: A small lighted scope is placed in the nose and the pharynx to evaluate for inflammation.<\/p>\n\n\n\n
Currently, there is no good standardized test to identify LPR. If parents notice any symptoms of LPR in their child, they may wish to discuss with their pediatrician getting a referral to see an otolaryngologist for evaluation. In the office, he or she may look directly at the voice box and related structures with a flexible scope or order a 24-hour pH monitoring of the esophagus. The otolaryngologist may also decide to perform further evaluation of the child under general anesthesia. This would include looking directly at the voice box (direct laryngoscopy), trachea and bronchi (bronchoscopy), and esophagus (esophagoscopy). LPR in infants and children remains a diagnosis of clinical judgment, based on history given by the parents, the physical exam, and endoscopic evaluations.<\/p>\n\n\n\n
Treatment of reflux in infants is intended to lessen symptoms, not to relieve the underlying problem, as this will often resolve on its own with time. A useful simple treatment is to thicken a baby\u2019s milk or formula with rice cereal, making it less likely to be refluxed.<\/p>\n\n\n\n
Several steps can be taken to assist the older child with GERD:<\/p>\n\n\n\n