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  • 1. GastroesophagealReflux in Infants and Children Melissa Velez
  • 2. What is Gastroesophageal Reflux Disease? When highly acidic contents of the stomach are refluxed back up to the esophagus  These gastric contents irritate and sometimes damage mucosal surfaces of the esophagus  It is a clinical condition that is severe enough to impact the patient’s life and/or damage the esophagus
  • 3. Gastroesophageal Reflux in Infants An infant will throw up after almost every feeding and many times between feedings. This is usually due to an incoordination or immaturity of the upper respiratory tract. Parents often worry that something more is wrong with the baby’s stomach  Ulcer  Not keeping enough food down to grow
  • 4. Common Symptoms It is unknown whether adults and infants have the same symptoms Infants are most likely to have:  Frequent or recurrent vomiting  Heartburn  Gas  Abdominal pain
  • 5. Symptoms Blamed on Refluxthat are Less Common in Infants Poor growth  Unintentional limiting child’s caloric intake Laryngeal Penetration  In children with neurological impairments  Aspirate refluxed stomach contents  Swallow-breathe patterns are not well coordinated
  • 6. Symptoms Blamed on Reflux (Continued) Chronic congestion and hoarseness  Results in stridor or laryngospasms Chronic asthma  Difficulty knowing whether reflux causes asthma or asthma causes reflux  Reported incidence of reflux ranging between 46-75%
  • 7. What happens with gastroesophageal reflux? In children with reflux there is some incoordination of the upper intestinal tract The infant will eat too fast but will not choke or gag during feedings which suggests that there is no difficulty getting food from their mouth to their esophagus Since the stomach contracts normally, most of the time the infant will not be bothered by reflux
  • 8. Differences Between Infants and Adults (Vomiting) An infant with reflux or an adult with an intestinal flu virus  An infant does not show discomfort before or after vomiting  An adult will show symptoms of being sick beforehand such as nausea, sweating, salivating, and swallowing
  • 9. Diagnosis Usually hearing the parents story and seeing the child is enough to determine this problem A few diagnostic tests that are given when further testing is recommended  Barium Swallow or Upper GI series  pH Probe  Endoscopy
  • 10. Barium Swallow X-ray allowing doctors to follow food down the infants esophagus into the intestines Doctor is able to see if there are twists, kinks, or a narrowing of the upper intestinal tract Not very reliable
  • 11. pH Probe Performed by the use of a small wire with an acid sensor Starts at the infants nose and ends at the bottom of the esophagus Sensor is left in place for 12-24 hours The severity of the reflux does not always correlate with the severity of the symptoms
  • 12. Endoscopy A flexible endoscope with lights and lenses are passed through the infants mouth. Esophagitis  Due to repeated exposure of the esophagus to stomach acid Less than half of the infants with severe symptoms do not develop esophagitis
  • 13. Treatment Positioning the baby  After feeding, put the baby on his stomach, and elevate the head Changing feeding schedules  Feed baby smaller amounts more often Dietary treatments  Parents are instructed to thicken their infants formula with cereal
  • 14. Treatment Continued Medications are used:  Lessen intestinal gas  Decrease or neutralize stomach acid  Improve intestinal coordination Surgery  Extremely rare  Nissen Fundoplication
  • 15. Research Recent experimental data suggests that Sudden Infant Death Syndrome (SIDS) may also be related to GERD. Another study included 72 children with chronic cough and normal findings on chest radiographs, GERD was implicated as the casue of symptoms in 15 % of the patients.
  • 16. References Ahuja, V., Lassen, L., & Yencha, M. (1999, September). Head and neck manifestations of gastroesophageal reflux disease. American Family Physician, 60, 873-86. Ashorn,M., Ruuska,T., & Karikoski,R. (2002, June). The natural course of gastroesophageal reflux disease in children. Scandinavian Journal of Gastroenterology, 37, 638-641. Center for Voice Disorders of Wake Forest University. Sheet on reflux. Retrieved on March 29, 2003, from http://bgsm.edu/voice/pt_info.html Center for Voice Disorders of Wake Forest University. Reflux and voice disorders. Retrieved on March 29, 2003, from http://www.bgsm. edu/voice/reflux.html Children’s Medical Center of the University of Virginia. Gastroesophageal Reflux in Infants. Retrieved on April 1, 2003, from http://www.people.virginia.edu/~smb4v/tutorials/reflux/ger.html