Occasional gastroesophageal reflux or GERD in children is normal, and it usually resolves after eliminating certain dietary factors. This is also called acid reflux, and it causes involuntary backflow of stomach acid into the food pipe (esophagus). However, frequent GERD requires medical evaluation to identify the cause. If left unmanaged, it may cause complications such as changes in the esophageal cells.
Read on to know the causes, symptoms, dietary modifications, and natural remedies for acid reflux in children and signs to seek medical care.
Acid Reflux Symptoms In Children
The classic symptoms of acid reflux in children include:
- Nausea and frequent regurgitation and vomiting almost immediately after eating something
- Regular heartburn, such as a burning and painful sensation in the chest, behind the breastbone, and a burning sensation in the middle of the stomach (in children 12 years and up). Younger kids might complain of vague pain in the abdomen, especially in the morning hours.
- Pain when you swallow, difficulty swallowing
- Refusal to eat
- Bad breath
- A sour taste in the mouth, especially in the mornings
- Choking and wheezing, when food enters the windpipe (rare) (1)
- Frequent cough episodes.
- Not gaining weight as expected.(only in cases of severe GERD)
When Does Acid Reflux Become Gastroesophageal Reflux Disease (GERD)?
If your child is experiencing acid reflux for more than twice a week continuously for a few weeks, then it could be GERD (1). A pediatrician’s consultation is imperative in such circumstances.
Some of the primary symptoms of acid reflux may also indicate other minor ailments. So you may not rush your child to the doctor if he or she vomits a little, complains of a stomach ache or refuses to eat once in a while. But if these symptoms are consistent and frequent, it is a cause for concern and warrants a trip to the doctor.
Causes Of Acid Reflux In Children
Acid reflux in children might occur when the lower esophageal sphincter (LES) relaxes too often or takes too long to relax. It causes the stomach acid to flow back to the esophagus.
If your child has occasional acid reflux, then it might be due to some lifestyle issues such as:
- Long gaps between meals
- Having more of chocolate, fatty and spicy foods
- Long-term usage of aspirin and a few over-the-counter nonsteroidal antinflammatory drugs such as ibuprofen and naproxen
- Long term use of steroids due to medical ailments
- Allergic condition of the esophagus (though quite rare) (3)
Occasional acid reflux could stop with some lifestyle changes. However, if acid reflux is severe and occurs more frequently, then the cause could lie deeper.
Causes Of GERD In Children
A few causes for GERD might be (2):
- Neurological impairment, such as cerebral palsy, which affects body movements and muscle coordination.
- Neuromuscular disorders such as congenital myopathy, which is a birth defect that causes progressive muscle weakness.
- Trachea-esophageal fistula surgery, which is corrective surgery for birth defects in the esophagus and trachea.
- Genetic conditions such as Trisomy 21, which is a condition of having an additional chromosome. Another condition is having a strong family history of GERD.
- Congenital diaphragmatic hernia, which is birth defects in the diaphragm muscles.
- Lung diseases, such as asthma and bronchiectasis.
- Significant prematurity, which happens when babies are born before 28 weeks of pregnancy.
Your doctor is the best person to assess and diagnose your child. In the next section, we tell you about some of the methods doctors might use to diagnose acid reflux or GERD.
Diagnosing Acid Reflux Or GERD In Children
The doctor would first check for the symptoms mentioned above. Medical history of the child and growth chart is often enough for the doctor to diagnose GERD in children. In some cases, further tests may be recommended. They include:
- A pH probe, which is a complicated test that determines the acid levels in the esophagus
- A Barium swallow or upper GI test, which is a special X-ray test highlighting the esophagus, stomach, and part of the small intestine (which has become obsolete in most of the countries now)
- Gastric emptying study
- Upper GI endoscopy, to look inside the stomach, esophagus and the small intestine (4)
- In the case of infants, only a milk scan or gastric emptying scintigraphy is performed to confirm the diagnosis of GERD.
Once the diagnosis is done, the doctor will recommend a course of treatment.
Treatment For Acid Reflux And GERD In Children
Starting from basic lifestyle and diet changes to medications, treatment for acid reflux and GERD depends on the severity of the symptoms. For younger children, doctors usually recommend changes in diet and lifestyle to prevent triggering the disorder. Here are some of them:
- Eat more often, but eat smaller meals each time. Avoid eating at least three hours before bedtime.
- Fatty foods, spicy foods, carbonated drinks are a no-no.
- If the child is obese, weight loss is recommended to decrease any possible pressure on the abdomen.
- Keep the head in an elevated position when sleeping, and preferring to sleep towards the left side.
- Avoid wearing tight clothes.
- Do not eat large or heavy meals before vigorous exercise, a game, or any other stressful event.
In addition to these tips, the doctor may also prescribe acid reflux medication such as:
- Proton pump inhibitors
- Histamine-2 blockers to help reduce the acid in the stomach
Surgical treatment might be recommended to children with chronic-relapsing GERD, and when all the alternative treatment options fail to give relief (4).
Remember that these medications should not be taken without the doctor’s advice. In most cases, a strict GERD diet and a healthy lifestyle can help in controlling the acid reflux symptoms in children.
Natural Remedies For Acid Reflux In Children
In addition to lifestyle changes and prescribed medicines, you could consider home remedies to reduce the symptoms of acid reflux and GERD in children. However, these may not cure reflux and cannot replace a doctor’s advice. Take your doctor’s advice before trying any of these remedies for your children.
1. Yogurt/ curd/ buttermilk
Eating yogurt might help reflux. Studies have shown that the fermentation of milk generates bioactive peptides, which could help in protecting the gut wall (5).
How to: Give the child half a cup of plain fresh yogurt every day after a meal.
2. Fennel seeds
Besides being an excellent digestive, fennel seeds might also help in reducing acidity. The seeds have an enzyme called anethole, which has antispasmodic properties that might help in reducing acid reflux (6).
How to: If your child is old enough to chew, then given them a spoonful of fennel seeds to chew after meals.
3. Aniseed and cumin seed
It is said that aniseed has a soothing effect on a troubled stomach, so might be helpful to reduce acid reflux.
- Get the child to chew some aniseed after eating food.
- Alternatively, soak the aniseed along with sugar candy in a cup of water for three to four hours. Strain the water and give it to the child to drink.
- You can also consider using aniseed paste to egg and meat dishes to help digest it properly, and prevent any heartburn.
Likewise, cumin seeds can be used to treat acid reflux in children. Besides using them in your food (Indian dishes), you can also get the child to chew these seeds if he has a burning sensation in the stomach. Then drink a glass of water immediately for relief.
4. Ginger root
Ginger root could be used for reducing acid reflux. Studies found that ginger root improved gastric emptying and gastroduodenal mobility in fasting and fed state (7).
- Clean a piece of ginger, peel and grate it. Extract the juice from it and mix it with a glass of warm water. Give it to the child to drink on an empty stomach.
- You can also use ginger in food to prevent acid reflux symptoms.
5. Basil leaves
Basil or Tulsi leaves are believed to be effective in treating the symptoms of acid reflux.
- Take a few basil leaves and boil them in a bowl of water. Let it reduce to one-third its original quantity. Let it cool and drink it in the morning.
6. Coconut oil
How to: Give one teaspoon of coconut oil to the child once a day (above two years of age). You can add the oil to a warm drink or use in foods. However, make sure your child is not allergic and also consult with your doctor before administering coconut oil orally to your child.
These home remedies help in alleviating the symptoms of acid reflux, but not curing it entirely.
Foods To Avoid To Prevent Acid Reflux
Is milk good for acid reflux? Can my children eat candy when they have acid reflux? What can they eat to prevent acid reflux?
If these are some of the questions you have, you should know about the foods that can trigger the symptoms of acid reflux.
- Peppermint or mint
- Spicy, oily or greasy foods – avoid all types of fast foods
Frequently Asked Questions
1. Is milk good for acid reflux in children?
Whole milk may not be good because the fat content in the milk can increase acid reflux. However, non-fat milk may act as a buffer and provide relief from acid reflux (9).
2. Does drinking water relieves acid reflux in children?
Water with some lemon juice and honey can help reduce acid reflux because they have an alkalizing effect. Also, eating watery foods such as cucumber, watermelon, and celery may dilute stomach acid and reduce discomfort (9).
3. Why does acid reflux in children worsen at night?
At night, when we lie down, the stomach acids usually travel back to the esophagus. This happens because the muscle that controls the opening between the esophagus and stomach does not close properly. The acid reaches the esophagus, causes heartburn, and children may feel their symptoms worsening. Eating small portions of early dinner, avoiding foods that trigger acid reflux, and using a pillow can reduce this problem (10).
Acid reflux in children occurring more than twice a week and continuing for a few weeks should be evaluated by a pediatrician. Nausea, frequent regurgitation, bad breath, refusal to eat, pain and difficulty swallowing, and regular heartburn are common signs and symptoms of acid reflux in children. This can also be associated with anatomic defects, neuromuscular disorders, and certain genetic disorders. Dietary modifications such as avoiding spicy and oily foods and eating small and more frequent meals than large meals may help relieve acid reflux. Medications such as antacids, proton pump inhibitors, or surgical treatment are recommended based on the underlying cause.
- Reflux in children; Medline Plus; US National Library of Medicine
- Ujjal Poddar; Diagnosis and Management of Gastroesophageal Reflux Disease (GERD): An Indian Perspective; Indian Pediatrics
- Gastroesophageal Reflux Disease (GERD)/Heartburn; Cedars Sinai
- Yvan Vandenplas et al.; Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology Hepatology and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology Hepatology and Nutrition (ESPGHAN); Journal of Pediatric Gastroenterology and Nutrition
- Bert J. M. van de Heijning Amelie Berton Hetty Bouritius and Olivier Goulet; GI Symptoms in Infants Are a Potential Target for Fermented Infant Milk Formulae: A Review; NCBI(2014)
- Shamkant B. Badgujar et al; Foeniculum vulgare Mill: A Review of Its Botany Phytochemistry Pharmacology Contemporary Application and Toxicology; NCBI(2014)
- Ann Ming Yeh and Brenda Golianu; Integrative Treatment of Reflux and Functional Dyspepsia in Children; NCBI(2014)
- Renan da Silva Lima Jane Mara Block; Coconut oil: what do we really know about it so far?; Oxford Academic Food Quality and Safety
- GERD Diet: Foods That Help with Acid Reflux (Heartburn).
- Why Does Your Heartburn Always Seem Worse at Night?