BROOKSVILLE - It is common for infants to spit up after a meal, but frequent vomiting among infants may be caused by GERD (gastroesophageal reflux disease).
Definition:
It refers to immaturity of lower esophageal sphincter function, manifested by frequent transient lower esophageal relaxations that results in retrograde flow of gastric contents into the esophagus.
Gastroesophageal reflux is classified as follows:
Physiological reflux: These patients have no underlying predisposing factors or conditions. Growth and development are normal, and pharmacologic treatment is typically not necessary.
Pathological reflux or gastroesophageal reflux disease (GERD): Patients frequently experience complications , requiring careful evaluation and treatment.
Secondary gastroesophageal reflux: This refers to a case in which an underlying condition may predispose to gastroesophageal reflux. Examples include asthma (a condition which may also be, in part, caused by or exacerbated by reflux and gastric outlet obstruction.
What Causes GERD in Infants and Children?
Most of the time, reflux in infants is due to a poorly coordinated gastrointestinal tract. Many infants with the condition are otherwise healthy; however, some infants can have problems affecting their nerves, brain or muscles.
Frequency
Approximately 85% of infants vomit during the first week of life, and 60-70% manifest clinical reflux at age 3-4 months.
Symptoms abate without treatment in 60% of infants by age 6 months, when these infants begin to assume an upright position and eat solid foods. Resolution of symptoms occurs in approximately 90% of infants by age 8-10 months.
Symptoms that persist after age 18 months suggest a higher likelihood of chronic gastroesophageal reflux.
Age: with a peak at age 1-4 months.
What Are the Symptoms of GERD in Infants and Children?
Frequent or recurrent vomiting
Crying and/or irritability, fussiness
Refusing to eat or difficulty eating (choking or gagging with feeding).
Heartburn, gas, colicky behavior (frequent crying and fussiness)
Feeding problems
Poor growth
Breathing problems
Recurrent wheezing
Recurrent pneumonia
Sandifer syndrome (ie, posturing with opisthotonus or torticollis)
4-Apparent life-threatening event (ALTE)
Apnea (cessation of breathing >20 seconds)
How Is GERD in Infants and Children Diagnosed?
Usually, parents provide enough details for the doctor to make a diagnosis. Sometimes, however, further tests are recommended. They include: 1-Barium swallow or upper GI series. This is a special X-ray test that uses barium to highlight the esophagus, stomach and upper part of the small intestine. This test may identify certain problems such as any obstructions or narrowing in these areas. 2-pH probe. This is currently considered the best test to diagnose reflux. In this test, a thin tube with a probe at the tip is placed through the nose into the esophagus. The tip, usually positioned at the lower part of the esophagus, measures levels of stomach acids. The frequency of reflux is monitored over a prolonged period of time, usually 24 hours. 3-Gastric emptying study. During this test, the child drinks milk or eats food mixed with a safe radioactive chemical. This chemical is followed through the gastrointestinal tract using a special camera. 4- Upper GI endoscopy.
What Are the Treatments for Acid Reflux in Infants and Children?
A-Medical treatment : The first line of treatment is to make changes to the child's lifestyle: 1-Elevate the head of the baby's crib or bassinet, 2-Hold the baby upright for 30 minutes after a feeding, 3-Thicken bottle feedings with cereal (do not do this without a doctor's supervision), 4-Change feeding schedules (discuss with the child's doctor first), 5-Try solid food (discuss with the child's doctor first).
Thickening of formula:
When excessive vomiting is associated with suboptimal weight gain. Even for infants with normal weight gain, thickened and reduced volume feedings may reduce the frequency and amount of vomiting episodes, for formula-fed infants older than 3 months, thickening is typically achieved by the addition of 1 tablespoon of rice cereal per 2 oz of formula.
Medications for GERD
Medications to neutralize or decrease stomach acid that are safe for infants and children include: 1-Acid blockers such as Pepcid, Tagamet or Zantac , 2--Proton-pump inhibitors such as Axid, Nexium, Prevacid and Prilosec, 3-others: Drugs to lessen gas include: Simethicone (such as Mylicon, Gaviscon).
Other medications that attempt to improve coordination of the gastrointestinal tract. These include: 1-Reglan. Reglan reduces symptoms of GERD by speeding up the digestion process. However, it is associated with many side effects, some of which can be serious. Reglan also can be associated with a number of drug interactions and may increase the risk of seizures in people who have seizures. 2-Erythromycin. This is an antibiotic that is usually used to treat bacterial infections. It causes strong stomach contractions which eases reflux; however, this effect is not lasting.
B-Surgery for GERD
Surgery is not often used to treat GERD in children. When it is necessary, the Nissen fundoplication is the most often performed surgery. During this procedure, the top part of the stomach is wrapped around the lower esophagus. In some patients, a pyloroplasty to improve gastric emptying may be performed at the same time.
Prognosis: Will My Baby Outgrow Infantile GERD?
Yes. Most babies outgrow infantile GERD. However, reflux can occur in older children. In either case, the problem usually can be managed easily.
Children with neurodevelopmental disabilities, including cerebral palsy,Down syndrome and other heritable syndromes associated with developmental delay, have an increased prevalence of gastroesophageal reflux. When these disorders are associated with motor abnormalities (particularly spastic quadriplegia), medical gastroesophageal reflux management is often particularly difficult, and suck and/or swallow dysfunction is often present.
Infants with neurological dysfunction who manifest swallowing problems at age 4-6 months may have a very high likelihood of developing a long-term feeding disorder.
Follow up: is needed to check for weight gain, symptoms and signs resolving, weaning of medications as the baby symptoms and signs gets better.
Information provided by Dr. Eid Guirguis, of Ocean Pediatrics Clinic, 1198 Mariner Blvd., Spring Hill, FL 34609, (352) 835-711.
source: hernandotoday
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