• About ACG
  • Donate
  • Store
  • Find a GI
  • Contact Your ACG Governor
  • Join
My ACG/Log In
American College of Gastroenterology
Advancing Gastroenterology, Improving Patient Care
  • Guidelines
  • ACG Blog
  • Patients
ACG 2023
  • Membership
    • My ACG/Log In
    • Renew/Pay Dues
    • Join
    • Benefits & Resources
    • Create ACG Website Log In
    • Advanced Practice Providers
    • Apply for Advancement to Fellowship (FACG)
    • GI Circles
    • About ACG – Trustees, Governance, Awards
    • Committees
    • Contact Your ACG Governor
    • Membership Directory
    • Find/Post A Job
  • Education
    • 2023 Annual Scientific Meeting
    • Claim CME & MOC
    • ACG Virtual Grand Rounds
    • Education Universe
    • Meetings, CME & MOC
    • Journal CME & MOC
    • Board Prep / Self-Assessment Tests
    • Podcasts
    • Training Program Resources
    • Educating Your Colleagues & Patients
    • Exhibitors & Sponsors
    • Endorsed Courses
  • Journals &
    Publications
    • The American Journal of Gastroenterology
    • Clinical and Translational Gastroenterology
    • ACG Case Reports Journal
    • Evidence-Based GI
    • Guidelines
    • ACG Magazine
    • ACG Blog
    • This Week in Washington DC
    • SmartBrief Newsletter
    • Podcasts
    • Journal CME & MOC
  • ACG Institute
    & Research
    • About the ACG Institute
    • The Center for Leadership, Ethics & Equity (The LE&E Center)
    • The G.U.T. Fund
    • Research Grants & Awards
    • Programs & Publications
    • Edgar Achkar Visiting Professorships
    • Visiting Scholar in Equity, Diversity, and Ethical Care
    • Advanced Leadership Development Program
    • Early Career Leadership Program
    • Clinical Research Leadership Program
  • Practice
    Management
    • Toolbox – GI Practice Resources
    • Prior Authorization Tools & Templates
    • GI OnDEMAND
    • GIQuIC Registry
    • Coding and Reimbursement
    • FDA Information
    • Making Sense of MACRA
    • This Week in Washington DC
    • Find/Post A Job
  • Public Policy
    • This Week in Washington DC
    • Contact Your ACG Governor
    • Contact Your Senator or Congressperson
    • Connect With Your State GI Society
  • Trainees
    & Residents
    • Benefits
    • Trainee Courses and Events
    • Mentoring Program
    • International GI Training Grants
    • Research, Fellowship Grants and Publishing
    • Question of the Week Competition
    • GI Jeopardy Competition
    • Resident Resources – Applying to GI Fellowship Programs
    • Program Director Resources
    • Find/Post A Job

Education

  • ACG 2023
  • Virtual Grand Rounds
  • Meetings Calendar
  • Education Universe
  • Journal CME & MOC
  • Board Prep/Self-Assessment Tests
  • Claim CME & MOC
  • Educating Your Colleagues & Patients
  • Training Program Resources
  • Exhibitors & Sponsors
  • Endorsed Courses

Guidelines

Journals & Publications

  • AJG
  • CTG
  • ACG Case Reports Journal
  • Evidence-Based GI
  • ACG Magazine
  • ACG Blog
  • SmartBrief
  • Podcasts
  • Journal CME & MOC

Membership

  • Join
  • Benefits & Resources
  • My ACG/Log in
  • Renew/Pay Dues
  • Membership Directory
  • Advanced Practice Providers
  • Apply for FACG
  • Join a Committee
  • GI Circles: Connect with Colleagues
  • Contact Your ACG Governor

Patients & Families

  • Find a Gastroenterologist
  • GI Health & Disease Resources

ACG Institute

  • About the Institute
  • The Center for Leadership, Ethics & Equity
  • Donate
  • Research Grants & Awards
  • Programs & Publications
  • Edgar Achkar Visiting Professorships
  • Visiting Scholar in Equity, Diversity, & Ethical Care
  • Advanced Leadership Development Program
  • Early Career Leadership Program
  • Clinical Research Leadership Program
  • Monographs

Trainees

  • Courses & Events
  • Find a Mentor
  • Research, Training Grants, & Publishing
  • Question of the Week Competition
  • GI Jeopardy Competition
  • Program Director Resources
  • GI Fellowship Program Information

Research

  • Health Equity Research Award
  • Established Investigator Bridge Funding Award
  • ACG/ASGE Epidemiologic Research Award in Gastrointestinal Endoscopy
  • Junior Faculty Development Award
  • Clinical Research Awards
  • Clinical Research Award Pilot Projects
  • Resident Clinical Research Award
  • Medical Student Research Award
  • Grant Recipients

Media & Press

  • Media Statements
  • Annual Meeting Press Information
  • Join Press List

Store

Find/Post A Job

Practice Management

  • Toolbox
  • Prior Authorization Tools & Templates
  • GI OnDEMAND
  • Coding & Reimbursement
  • ASC Quality Reporting
  • GIQuIC Registry
  • FDA Information
  • Making Sense of MACRA

Public Policy

  • This Week in Washington DC
  • Contact Your ACG Governor
  • Contact Policy Makers
  • Legislative Action Center
  • Legislative & Public Policy Council
  • State Society Information

About

  • Board of Trustees
  • Board of Governors
  • Committees
  • Governance
  • History
  • Awards
  • International Affiliate Societies
  • Auxiliary
Gi.org / Patients / Gastroesophageal Reflux in Children

Gastroesophageal Reflux in Children

  • GI Health and Disease
  • Recursos en Español
  • Video and Audio Podcasts
  • What is a Gastroenterologist?
  • Brochures
Digestive Health Topics A-Z
Abdominal Pain Syndrome Belching, Bloating, and Flatulence Colonoscopy Colorectal Cancer Common GI Symptoms Covid-19 Gastroparesis Hepatitis C Inflammatory Bowel Disease Irritable Bowel Syndrome See All Topics (A-Z)
Find a
Gastroenterologist

Locate an ACG member gastroenterologist in your area.

  • Basics
  • Print

Overview

  • What is gastroesophageal reflux?

    Gastroesophageal reflux is the bringing up or regurgitation of stomach contents or acid into the esophagus (the swallowing tube). Almost everyone refluxes at some point during the day especially after meals. What distinguishes normal reflux from pathologic or abnormal reflux is how often reflux occurs and if it causes symptoms or damage to the esophagus. Reflux is being increasingly recognized in children and adolescents. Although the symptoms in teenagers may be similar to those seen in adults, the symptoms in infants and younger children may differ enough so that they are not recognized as being due to reflux.

Symptoms

  • Is it normal if my infant spits up?

    Almost all infants reflux or regurgitate a portion of their feeding at one time or another. What distinguishes normal regurgitation from abnormal regurgitation is how often the reflux occurs, if it is associated with discomfort, and if it results in other complications. These complications include poor weight gain known as “failure to thrive”, breathing difficulties such as infrequent breaths or apnea, asthma symptoms such as wheezing, or a hoarse voice or cry. Other complications of reflux are aspiration, which is when the refluxed stomach contents reach the lungs, pneumonia due to aspiration, or inflammation of the esophagus called esophagitis. Spitting up blood or material that looks like old “coffee grounds” is rarely seen and requires immediate evaluation by a physician.

    Reflux symptoms in infants tend to improve as they get older, usually by 12 to 15 months of age. This is because as infants get older their stomach is able to empty quicker and their esophagus lengthens, therefore there is less material in the stomach to regurgitate. Infants who reflux or regurgitate will not necessarily have problems with reflux as they get older or as adults.

  • Is vomiting in my baby always due to gastroesophageal reflux?

    There are a number of reasons, other than reflux, that a baby may vomit. Babies may be allergic to the milk or soy protein that they are getting in their formula, or proteins in their mother’s diet if they are breast fed and this can result in irritability, vomiting, poor weight gain and blood in the bowel movements. This is treated with a change to a specialized formula where the proteins are broken down to make them less allergenic (allergy causing). Babies can be born with problems where the intestine is not formed or positioned properly or is blocked. These types of problems are usually found in the immediate newborn period but can present later in some infants. A combination of x-rays and or endoscopy (looking at the lining of the stomach and upper intestine and/or colon with a long tube with a video camera at the tip) is usually helpful to make this diagnosis.

    Between 4-8 weeks of age infants can develop a condition known as pyloric stenosis. This results in significant and forceful vomiting and is usually associated with poor weight gain and possibly weight loss. Parents of infants with this problem describe their child’s vomiting as projectile. Pyloric stenosis is currently treated with surgery. There are other non-gastrointestinal causes of vomiting in infants and young children including hormonal problems, kidney problems and problems with increased pressure on the brain. These are unusual conditions but patients should be tested for these problems if their physician feels that their symptoms are not typical or they are not responding to treatment for their reflux.

  • What are the symptoms of reflux in older children and adolescents?

    Reflux symptoms in children are variable. Children may be unable to communicate typical reflux symptoms such as heartburn. They may complain of generalized abdominal pain, frequently around the area of the belly button and on occasion may complain of chest pain. Often children will report a feeling that they need to throw up and on occasion will describe that they get a taste in their mouth as if they have thrown up. Other children will report that they feel that the food is coming back up and that they then re-swallow it. Occasionally they will report a feeling that food is not going down correctly or feels like it is getting stuck. Some patients may complain of asthma symptoms such as cough or wheezing that are worsened by reflux. Even though children may not relate reflux symptoms to eating, obtaining a dietary history for foods and medicines that may trigger or worsen reflux is important.

Diagnosis

  • How is the diagnosis of reflux made?

    Reflux is usually diagnosed based on symptoms and physical examination. X-rays are generally not helpful in diagnosing abnormal reflux although they are often used to exclude other problems that may mimic reflux. Performing an upper intestinal endoscopy with biopsies can be helpful to determine if inflammation of the esophagus is present. The test currently considered most helpful in making the diagnosis of acid reflux is a pH/ impedance probe. This probe is a small tube inserted through the nose into the esophagus that continuously measures how often acid is being regurgitated into the esophagus. There are normal expected values for both children and adults.

Treatment

  • What are treatment choices for children and adolescents with gastroesophageal reflux?

    There are many medications available to treat gastroesophageal reflux. Many of these medications have been used successfully to treat children. Dosages of medication must be modified for a child’s weigh and they require monitoring to reduce possible long-term side effects. The most common medications reduce or turn off the production of acid in the stomach. They include H2 blockers and proton pump inhibitors (PPis). Other medications include agents that help empty the stomach. Diet is an important part of reflux management and children and teenagers with reflux should avoid the products listed below. Medications such as aspirin, ibuprofen, nonsteroidal anti-inflammatory medicines (NSAIDs) and alcohol based products should be avoided if possible in children with reflux. Rarely a surgical procedure called a fundoplication (or wrap) is required for severe reflux. This procedure is usually reserved for patients with severe symptoms or complications of reflux that do not respond to standard medications and dietary treatment. 

    Foods to avoid if you have reflux

    Spicy, acidic or tomato based foods
    Fatty foods
    Citrus products including citrus juices
    Apple juice
    Caffeinated drinks – cola, tea, coffee, hot chocolate
    Chocolate and licorice

Author(s) and Publication Date(s)

Marsha H. Kay, MD, FACG The Cleveland Clinic, Cleveland, OH, and Annette E. Whitney, MD, Digestive Health Associates of Texas, Dallas, TX – Updated December 2012.

Marsha H. Kay, MD, The Cleveland Clinic, Cleveland, OH, and Vasundhara Tolia, MD, Children's Hospital of Michigan, Detroit, MI – Published September 2004.

Return to Top

Advancing gastroenterology, improving patient care

Education

  • ACG 2023
  • Virtual Grand Rounds
  • Meetings Calendar
  • Education Universe
  • Journal CME & MOC
  • Board Prep/Self-Assessment Tests
  • Claim CME & MOC
  • Educating Your Colleagues & Patients
  • Training Program Resources
  • Exhibitors & Sponsors
  • Endorsed Courses

Guidelines

Journals & Publications

  • AJG
  • CTG
  • ACG Case Reports Journal
  • Evidence-Based GI
  • ACG Magazine
  • ACG Blog
  • SmartBrief
  • Podcasts
  • Journal CME & MOC

Membership

  • Join
  • Benefits & Resources
  • My ACG/Log in
  • Renew/Pay Dues
  • Membership Directory
  • Advanced Practice Providers
  • Apply for FACG
  • Join a Committee
  • GI Circles: Connect with Colleagues
  • Contact Your ACG Governor

Patients & Families

  • Find a Gastroenterologist
  • GI Health & Disease Resources

ACG Institute

  • About the Institute
  • The Center for Leadership, Ethics & Equity
  • Donate
  • Research Grants & Awards
  • Programs & Publications
  • Edgar Achkar Visiting Professorships
  • Visiting Scholar in Equity, Diversity, & Ethical Care
  • Advanced Leadership Development Program
  • Early Career Leadership Program
  • Clinical Research Leadership Program
  • Monographs

Trainees

  • Courses & Events
  • Find a Mentor
  • Research, Training Grants, & Publishing
  • Question of the Week Competition
  • GI Jeopardy Competition
  • Program Director Resources
  • GI Fellowship Program Information

Research

  • Health Equity Research Award
  • Established Investigator Bridge Funding Award
  • ACG/ASGE Epidemiologic Research Award in Gastrointestinal Endoscopy
  • Junior Faculty Development Award
  • Clinical Research Awards
  • Clinical Research Award Pilot Projects
  • Resident Clinical Research Award
  • Medical Student Research Award
  • Grant Recipients

Media & Press

  • Media Statements
  • Annual Meeting Press Information
  • Join Press List

Store

Find/Post A Job

Practice Management

  • Toolbox
  • Prior Authorization Tools & Templates
  • GI OnDEMAND
  • Coding & Reimbursement
  • ASC Quality Reporting
  • GIQuIC Registry
  • FDA Information
  • Making Sense of MACRA

Public Policy

  • This Week in Washington DC
  • Contact Your ACG Governor
  • Contact Policy Makers
  • Legislative Action Center
  • Legislative & Public Policy Council
  • State Society Information

About

  • Board of Trustees
  • Board of Governors
  • Committees
  • Governance
  • History
  • Awards
  • International Affiliate Societies
  • Auxiliary
American College of Gastroenterology 11333 Woodglen Dr, STE 100, North Bethesda, MD 20852-3071 | (301) 263-9000 Contact Us
©2023 American College of Gastroenterology Privacy Policy