Gastro-oesophageal reflux in kids and teens: GP-guide

Summary: Gastro-oesophageal reflux disease (GORD) is a prevalent condition among children and teens, causing symptoms such as heartburn, nausea, and difficulty swallowing. While it can often be managed through lifestyle changes, diet modifications, and medications, untreated GORD may lead to complications such as oesophagitis, respiratory issues, and growth delays. Diagnosing GORD involves a medical evaluation and, in some cases, additional tests. Parents should monitor symptoms and seek medical advice if symptoms persist or worsen. Telehealth services like Hola Health offer quick and convenient access to GPs for consultations, prescriptions, and medical certificates, making healthcare more accessible for families.

Gastro-oesophageal reflux disease (GORD) is a common condition that affects many children and teens. According to available data, the prevalence of GERD in Australian teenagers is estimated to be around 11.6%. When stomach acid or food contents flow back into the oesophagus, it may cause discomfort like nausea, vomiting, and heartburn. While GORD is often linked with adults, it can also impact younger individuals and might be mistaken for other issues due to its broad range of symptoms. Understanding GERD in kids and teens is crucial for proper management, ensuring they get back to doing things they love.  

Signs & symptoms of gastro-oesophageal reflux in children

Common symptoms of GORD in children include: 

• Frequent burping 
• Spitting up 
• Irritability during feeding 
• Back-arching after meals 
• Poor weight gain 
• Heartburn 
• Vomiting 
• Regurgitation 
• Nausea 
• Difficulty swallowing 
• Stomach pain 
• Chronic coughing 
• Chest pain 
• Sore throat 
• Trouble sleeping 
• Gagging 
• Choking 
• Wheezing 
• Having bad breath 
• Loss or decay of tooth enamel 
• Loss of appetite 

If your child exhibits any of these symptoms frequently, it’s essential to seek advice from a healthcare professional for proper diagnosis and treatment.    

Causes

GORD is frequently caused by issues that affect the lower oesophageal sphincter (LES), a muscle at the lower end of the oesophagus. The LES opens to allow food into the stomach and closes to prevent reflux. If the LES relaxes too much, acid can rise into the oesophagus, leading to heartburn or regurgitation.  

Babies are more prone to having a weak lower oesophageal sphincter (LES), which causes it to open when it should stay closed. As food or milk is digested, the lower oesophageal sphincter (LES) opens, which permits stomach contents to move back into the oesophagus. Occasionally, the contents rise completely, causing the baby to vomit. In other cases, the stomach contents only travel partway, causing heartburn or breathing problems. In some cases, there are no symptoms at all.   

Problems caused by repeated reflux in kids

Repeated reflux in children can lead to various complications that affect their growth, comfort, and overall health. Some common problems include: 

1. Insufficient weight gain and growth challenges: Consistent reflux can hinder a child's ability to absorb nutrients properly, resulting in inadequate weight gain and slow growth.
2. Inflammation of the oesophagus (oesophagitis): Continuous contact with stomach acid can lead to irritation and swelling in the oesophagus, causing pain, trouble swallowing, and discomfort.
3. Respiratory issues: Acid reflux can provoke breathing problems such as chronic coughing, wheezing, asthma-like symptoms, and aspiration pneumonia may occur if stomach acid enters the respiratory tract, leading to recurrent infections.
4. Sleep disruptions: Symptoms of reflux often intensify at night as a result of lying down, leading to discomfort and interrupted sleep, affecting a child's overall health and development.
5. Oral health complications: Stomach acid that reaches the mouth can damage tooth enamel, resulting in cavities, sensitivity, and other long-term dental problems.
6. Reluctance to eat: Discomfort and pain caused by reflux can make children hesitant to eat, resulting in feeding challenges and nutritional deficits.

Diagnosis

Diagnosing reflux in children requires a comprehensive medical history, assessment of symptoms, and sometimes diagnostic tests to exclude complications. 

1. Medical history and physical examination: A doctor will inquire about symptoms, feeding habits, weight gain, and any signs of distress. A physical evaluation will determine overall health.
2. pH monitoring test: A slender tube with a sensor is positioned in the oesophagus to track acid levels over 24 hours, confirming the severity of reflux.
3. Upper gastrointestinal (GI) endoscopy: A flexible tube equipped with a camera is introduced into the oesophagus and stomach to check for inflammation, ulcers, or structural issues.
4. Barium swallow (upper GI series): The child consumes a barium solution, and X-rays monitor its passage through the digestive system to identify anatomical problems.
5. Oesophageal manometry: This assessment gauges the strength and function of the oesophageal muscles to ascertain if they are effectively preventing reflux.

Also read: How to Tell the Difference Between Gastro and Food Poisoning?  - Hola Health

Possible complications of GERD in a child

Untreated gastroesophageal reflux disease (GOED) in children can lead to several complications affecting their growth, comfort, and overall health: 

Esophagitis:

Prolonged contact with stomach acid can lead to inflammation of the oesophagus, resulting in pain, irritation, and difficulties in swallowing.

Oesophageal structure:

Repeated damage to the oesophagus can lead to scar tissue formation, which narrows the oesophagus and makes swallowing difficult.

Respiratory problems:

Acid reflux can ascend into the airways, causing persistent coughing, wheezing, symptoms similar to asthma, and repeated episodes of pneumonia.

Feeding and growth issues:

Discomfort and pain associated with GERD might lead a child to eat less, resulting in inadequate weight gain, malnutrition, and delays in growth.

Sleep disturbances:

Symptoms of reflux may intensify at night, leading to frequent awakenings and poor sleep quality, affecting a child's overall health.

Dental erosion:

When stomach acid reaches the mouth, it can wear down tooth enamel, raising the risk of cavities and causing tooth sensitivity.

Barrett’s oesophagus (rare):

Untreated GORD over an extended duration can cause alterations in the lining of the oesophagus, heightening the risk of future complications, including oesophageal cancer.  

Treatment

Treatment for gastroesophageal reflux disease (GORD) in children focuses on reducing symptoms, preventing complications, and improving quality of life: 

1. Changes in diet and lifestyle: Encourage the consumption of smaller, more frequent meals and steer clear of foods that may trigger symptoms, such as citrus, chocolate, spicy dishes, and caffeine. Keeping the child in an upright position after eating and avoiding late-night meals can also be beneficial. Avoid meals at least 2-3 hours before bedtime.
2. Maintaining a healthy weight: If the child is overweight, achieving a healthy weight can alleviate pressure on the stomach and help minimise reflux symptoms.
3. Raising the head during sleep: For older children, elevating the head of the bed can assist in preventing acid from backing up into the oesophagus at night.
4. Medications: Healthcare professionals may recommend antacids, H2 blocker (like  famotidine), or proton pump inhibitors (like omeprazole) to lower stomach acid production and relieve symptoms.
5. Addressing underlying issues: If GORD is associated with other health conditions such as food allergies or delayed gastric emptying, treating those issues can help decrease reflux symptoms.
6. Surgical options (for severe cases): In rare instances where GORD is severe and unresponsive to other treatments, a surgical procedure known as fundoplication might be an option to reinforce the lower oesophageal sphincter.

Also read: What can be mistaken for gastro?

When to call a GP?

If your child's GORD symptoms continue even after making lifestyle adjustments, or if they suffer from frequent vomiting, difficulty swallowing, or are unwilling to eat, it's important to consult a GP. Medical advice should be sought if your child is experiencing poor weight gain, ongoing coughing, wheezing, or any indications of respiratory problems. Be vigilant for signs such as severe chest pain, recurring sore throat, or blood in vomit or stool, as these may signify complications. If GORD is interfering with sleep, causing feeding issues, or negatively affecting overall health, a doctor can help with diagnosis and offer treatment options. It is crucial to seek immediate medical help if your child exhibits signs of dehydration, vomiting with blood, black stools, unexplained weight loss, severe chest pain, persistent difficulty swallowing, or worsening symptoms despite receiving treatment. Timely intervention can help prevent complications and ensure effective management. 

Get help via telehealth

Telehealth provides a convenient option for consulting an online doctor about your child's GORD symptoms without requiring an in-person appointment. During a virtual visit, a doctor can evaluate symptoms, suggest dietary and lifestyle modifications, and prescribe medications if necessary. Telehealth proves particularly beneficial for managing ongoing symptoms, follow-up appointments, or making adjustments to treatment plans. If symptoms deteriorate or suggest complications such as breathing difficulties, inadequate weight gain, or significant discomfort, the doctor may recommend further testing or a referral to a specialist. Online consultations offer rapid access to medical guidance, making it easier to ensure your child receives the necessary care while saving time. Nonetheless, for severe symptoms, an in-person consultation may still be required. Online GP chat available 24/7 mostly offers rapid access to medical guidance, sick leave certificate or telehealth medical certificate, making it a practical choice for addressing GORD without requiring an in-person appointment. 

Hola Health offers a fast and convenient way to access healthcare with doctors on demand anytime, anywhere in Australia. Whether you need a night doctor or a quick consult during the day, Hola Health connects you with AHPRA-registered Australian GPs within 15 minutes: 

• Online doctor appointment: Speak to an Australian GP or an after-hours GP for immediate advice and treatment options via telehealth Australia. 
• Multi-Day and same day medical certificate online: Request medical certificates for single or multiple days, perfect for work, school, or carer responsibilities. 
• Prescriptions online: Receive escripts for medications sent directly to your local pharmacy or delivered to your door. 
• Online referrals: Get specialist referrals or referrals for pathology or radiology without the hassle of waiting for a clinic appointment. 

With Hola Health’s web doctor service, you can book telehealth appointments 24/7, ensuring quick and reliable care when it’s needed most by home doctors. Trusted by thousands of Australians, Hola Health makes healthcare accessible and stress-free via 24-hour doctors. 

In conclusion, managing GERD in kids and teens doesn’t have to be a hassle! With proper care, smart food choices, medications, and some lifestyle tweaks, most children can feel better and get back to their active lives. Parents should team up with healthcare professionals to ensure the best care for their child’s health.