Gastroesophageal Reflux Disease (Children)

Gastroesophageal reflux (GER) is common in babies. Reflux means to flow backward or return. GER is the passage of gastric (stomach) content into the lower oesophagus (food pipe), causing spit up.

Gastroesophageal reflux is a normal physiological process that can occur several times a day. 20% to 30% of all babies regurgitate more than three times per day during their first few months of life1. This is because the junction or angle between the food pipe and stomach is not as tight as in older infants and children.

Majority of the regurgitations are benign and resolve as the child gets older. Most babies with regurgitation do not need investigations and treatment.

Babies would typically grow out of spitting up after a feed at about six months of age. In addition, solids (e.g. pureed foods or rice cereals) are introduced at this time. These solids are harder to spit up after feeding compared to milk. Even if the baby has a tendency to regurgitate, these solids tend to stay down better.

Gastroesophageal Reflux Disease (GERD), on the other hand, is not as common. It is a more severe form of reflux, which may result in pain and discomfort for the baby.

Most children will outgrow GERD. However, if there is a structural problem with the food pipe or an underlying neuromuscular problem (issue with the nerves or muscles in the body), then these children may not outgrow GERD.

Source: 1National Center for Biotechnology Information

GERD occurs when GER is associated with complications such as inflammation of the food pipe (oesophagitis).

The most common symptom is vomiting after feeding. Your baby may also present with symptoms that suggest pain and discomfort such as crying and fussing, refusing milk feeds or when the spit up contains blood streaks.

GER can usually be diagnosed by doctors based on your baby's symptoms. A consultation with a paediatrician specialising in gastroenterology may be needed if your baby has atypical symptoms.

Investigations including 24-hour pH impedance monitoring, upper gastrointestinal contrast study and an endoscopy may be performed after an assessment.

As majority of infants with GER improve with time, investigations are not necessary. The doctor spends much of the consultation reassuring the caregiver. Switching to a hydrolysed formula may be beneficial if your child is intolerant or allergic to cow's milk protein.

First-line medications usually include an acid suppressant agent with the addition of a prokinetic agent. Surgery for fundoplication and insertion of gastrostomy feeding tube can be discussed with the paediatric surgeons, especially in cases whereby the child is neurologically-impaired, has persistent failure to thrive or recurrent aspiration etc.

​If your baby is happy, feeding well and putting on weight well, there is no reason to worry and no need for medications. However, if the vomiting is associated with a lot of crying, fussing, arching, turning away (feed refusal) and decreased feeding (less than what is expected of a child of a given age or weight), this would be a cause for concern. If your child does not undergo treatment, he or she will refuse feeding and his or her weight gain will be affected.