This picture is a good window into how we really believe a lot of our patients feel when they experience reflux. We get a great deal of questions about reflux, so I thought it would be helpful to do a brief post on what exactly we see, observe and gain from history when evaluating a child for reflux.
Reflux is described in many different ways among medical providers. First, there is often a distinction made between GER (gastroesophageal reflux) and GERD (gastroesophageal reflux disease). In the clinical practice guidelines from 2009, two of our professional organizations, The North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN), differentiated them this way:
“GER is the passage of gastric contents into the esophagus with or without regurgitation and vomiting. GER is a normal physiologic process occurring several times per day in healthy infants, children, and adults. Most episodes of GER in healthy individuals last <3 minutes, occur in the postprandial (immediately after eating) period, and cause few or no symptoms. In contrast, GERD is present when the reflux of gastric contents causes troublesome symptoms and/or complications.”
We do not treat children with medications who have gastroesophageal reflux, even if we call it “reflux”. These children do not have symptoms, other than the occasional effortless spitting up while maintaining their usual temperament and activities of daily living. These children most often progress seamlessly from breast or bottle feeding, to baby food stage 1 purees, followed baby food stage 2 purees, then meltable solids, to soft chewable table foods and end up eating solid table foods.
The children who come to our clinic have GERD. These children may have a number of the following symptoms:
- forceful vomiting with associated crying, screaming, refusal to eat immediately following a vomiting episode – and not with current illness
- spitting out food, refusing to swallow after chewing
- inability to progress beyond a stage of normal childhood eating
- choking with eating or drinking
- difficulty sleeping (waking frequently with coughing, choking, crying)
- head turning or swatting when caregiver attempts to feed
- no interest in eating, only preferring to drink
- preferential eating (only eating foods with specific packaging, from certain stores, with certain colors)
- reswallowing, “chewing” on contents that come back into the mouth from the stomach
- eye tearing with eating
Because GERD symptoms vary in each of our patients, your child actually may experience GERD without any of the above symptoms. An example of this would be a neurologically compromised patient who turns his/her head slightly and grimaces each time he/she is fed through his/her gastrostomy tube.
Our team works tirelessly to evaluate each patient that we encounter to the best of our ability. The use of medications for the treatment of GERD is controversial, as there are risks associated with any medication, especially in pediatrics.
The most important first step in choosing the right diagnosis and associated treatment is obtaining a very detailed history, picking up on any subtlety that could potentially be related to GERD. We have found that treatment of GERD with both formulas and medications positively impacts outcomes of our patients.
I look forward to sharing specific treatment options in future posts, to best inform all of our parents about benefits and risks, along with candid commentary about why we treat patients the way that we do. In short, it’s because we genuinely care about best outcomes…and use a variety of ways to get there.