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The Degree of GERD, by Dr. Suzanne P. Nelson
Gastroesophageal reflux is common in children. More than 60% of infants at four months of age regurgitate at least once a day; in infants, the primary manifestation of reflux is regurgitation. As children become older, 5% to 10% complain of acid reflux symptoms on at least a weekly basis; these symptoms include not only regurgitation but also chest pain and other symptoms similar to those seen in adults. Pediatricians generally try to distinguish between gastroesophageal reflux and gastroesophageal reflux disease (GERD). We consider that a child has GERD when he demonstrates some complication of reflux, for example, poor growth, feeding problems, pain, anemia, and extraintestinal manifestations such as cough, chronic laryngitis, or asthma. In the Medical Crossfire, Dr. Lange commented that GERD is probably best defined as symptomatology severe enough to cause a patient to seek medical care. This definition cannot be used by pediatricians, however, as our job often entails explaining to parents that what their child is doing is perfectly normal. Just because a parent brings a child to us does not mean the child has a disease. Much of our time, particularly with infants, is spent reassuring parents that it is normal for babies to spit up and that they probably do not require medicine if there are no attendant problems. Another difference in the management of adults and children is that when pediatricians conduct endoscopies to evaluate gastroesophageal reflux, the esophagus is routinely biopsied—whether or not it appears abnormal. There are two reasons for this. First, over the past few years, we have come to appreciate the significance of eosinophilic esophagitis, which presents with symptoms much like those of gastroesophageal reflux. It is, however, probably an allergic disorder, and it does not respond to medications or even surgery typically used for reflux. Second, endoscopy may reveal evidence of microscopic esophagitis due to reflux disease that cannot be detected with the naked eye. Treatment considerations differ depending on age. Most infants who have gastroesophageal reflux or gastroesophageal reflux disease can be treated conservatively, meaning that thickening the babies’ feedings, keeping the baby upright after feeding, and being careful not to overfeed can help with regurgitation. As children get older, it is more likely that medications would be required; at this juncture, we use medicines similar to those used in adults. I would urge my primary-care colleagues who treat children to question their young patients about reflux symptoms directly. Older children—those aged 10 years and more—tend to report more reflux symptoms than their parents appreciate. It is crucial for practicing physicians to ask children about reflux symptoms because parents may not know that their children are experiencing acid regurgitation, nausea, or other symptoms—and children who do develop gastroesophageal reflux disease can suffer serious complications. |
Children's Gastroenterology Specialists, S.C., 2551 Compass Road Suite 110, Glenview, IL 60026
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