Understanding and managing acid reflux at different stages of life. Kids don't suffer heartburn like adults, but they still have reflux
Is a pediatric gastroenterologist at the Children’s Center for Digestive Health Care / GI Care for Kids, whose books on nutrition for parents led him to start Nutrition4Kids with his co-founders.
Article in collaboration with:
Dr. Stan (Stan Cohen MD)
Acid reflux, also known as gastroesophageal reflux disease (GERD), affects people of all ages. It
occurs when stomach acid flows back into the esophagus, causing discomfort and potential
complications. Reflux can vary in its presentation and impact depending on a person's age, from
infancy to adulthood. So it shouldn't be a surprise that understanding and managing this condition is
different for the different age groups.
Infants and acid reflux
Many infants experience a form of acid reflux known as gastroesophageal reflux (GER), which is
often considered normal during the first year of life.
Symptoms: Common signs of reflux in infants include spitting up, fussiness during or after feeds,
arching of the back, and difficulty sleeping. While the vast majority are mild, the more severe cases,
known as gastroesophageal reflux disease (GERD) can be associated with respiratory problems,
posturing (a condition called "Sandifer's Syndrome") or slightly bloody regurgitation.
Causes: In infants, reflux occurs because the lower esophageal sphincter (LES), a ring-like area that
separates the esophagus from the stomach, is not fully developed at birth. As a result, stomach
contents can flow back into the esophagus more easily.
Management: Most cases of infant reflux resolve on their own as the LES matures. Feeding
adjustments, such as smaller, more frequent meals and burping after feeds, can help manage
symptoms. In advanced cases, healthcare providers may recommend specialized formula,
thickening routine formula or medications.
Children and acid reflux
Not all infants outgrow reflux. Children, especially those between the ages of 1 and 12, can also
experience acid reflux.
Symptoms: Common symptoms in children include heartburn (a burning sensation in the chest),
regurgitation and / or abdominal pain. More severe cases can have more frequent episodes, asthma,
difficulty swallowing, or repeated bouts of sinus or ear infections.
Causes: In children, reflux may result from a variety of factors, including a weak LES, obesity,
certain medications, or underlying conditions like hiatal hernias. It is important to recognize that
sometimes allergies or eosinophilic esophagitis (EoE) can masquerade as GERD.
Management: Lifestyle modifications often can help manage reflux in children. These include
maintaining a healthy weight, avoiding trigger foods, eating smaller meals, and not lying down
immediately after eating. In some cases, doctors may prescribe medications to reduce stomach acid
production or strengthen the LES.
Teenagers and acid reflux
Acid reflux can also affect teenagers, and it may be more challenging to manage due to lifestyle
factors. Here's what teenagers should be aware of:
Symptoms: Teens may experience heartburn, regurgitation, chest pain, chronic cough, or a
sensation of a lump in the throat.
Causes: Lifestyle choices, such as consuming high-fat or spicy foods, excessive caffeine or
carbonated beverages, smoking, and alcohol consumption, can contribute to acid reflux in
teenagers. At times, what appears to be reflux can be caused by eosinophilic esophagitis or a
condition called "rumination," where some one brings up the contents of their stomach, rechewing
and re-swallowing their food.
Management: Encouraging healthy eating habits, avoiding trigger foods and beverages, and not
eating late at night can help manage reflux symptoms. In some cases, healthcare providers may
recommend medications, lifestyle counseling, and / or breathing exercises. Surgery is rarely needed.
Adults and acid reflux
Acid reflux is prevalent among adults, and its impact can become more significant as people age.
Symptoms: Adults with reflux may experience heartburn, regurgitation, chest pain, chronic cough,
hoarseness. It's essential to be aware of "red flag" symptoms like unexplained weight loss, difficulty
swallowing, or vomiting blood, which may require immediate medical attention.
Causes: Several factors contribute to reflux in adults, including obesity, smoking, excessive alcohol
consumption, dietary choices, medications, pregnancy and certain medical conditions like hiatal
hernias.
Management: Lifestyle modifications play a crucial role in managing reflux in adults. These include
maintaining a healthy weight, avoiding trigger foods and beverages, eating smaller meals, not lying
down immediately after eating, and raising the head of the bed. Medications, including proton pump
inhibitors (PPIs) and H2 receptor antagonists, are available at pharmacy counters in low doses, with
stronger doses sometimes needed to reduce stomach acid production and alleviate symptoms. In
severe cases or when complications occur, surgical procedures may be considered.
Seniors and acid reflux
As people age, the prevalence of acid reflux may increase, and the impact can be more severe.
Here's what seniors should be aware of:
Symptoms: Seniors may experience persistent heartburn, regurgitation, chest pain, difficulty
swallowing, and an increased risk of developing complications like Barrett's esophagus or
esophageal cancer.
Causes: Aging can weaken the LES and reduce esophageal motility (the motion of the esophagus
moving food down to the stomach, increasing the risk of reflux. Medications commonly used by
seniors, such as nonsteroidal anti-inflammatory drugs (NSAIDs) and certain osteoporosis
medications, can also contribute to reflux.
Management: Seniors should focus on dietary choices, maintaining a healthy weight, and avoiding
trigger foods and beverages. Regular physical activity can help improve esophageal motility.
Medications, including PPIs, may be prescribed, but healthcare providers should monitor their long-
term use carefully. In severe cases, seniors may need surgical interventions.
Complications and prevention
Regardless of age, uncontrolled acid reflux can lead to complications like esophagitis (inflammation
of the esophagus), strictures (narrowing of the esophagus), Barrett's esophagus (a precancerous
condition), and even esophageal cancer. Therefore, prevention and management are crucial.
Testing
When more than mild symptoms exist or the reflux seems to be worsening, testing is usually
needed.
• X-rays: Several different procedures may be needed. The most common, is an upper GI to
evaluate for a hiatal hernia or another cause of the reflux
• Endoscopy: This test is done to determine whether there is any damage to the esophagus or
stomach and to rule out other causes.
• Probes: a thin wire may be placed in the esophagus to determine the number and severity of
the episodes.
• Allergy testing: At times, allergies may contribute to or be confused with, acid reflux.
Preventive measures for reflux include:
- Maintaining a healthy weight.
- Avoiding trigger foods and beverages, such as citrus, tomatoes, spicy foods, coffee, and
alcohol, though not all of these will cause problems for everyone. - Eating smaller, more frequent meals.
- Not lying down immediately after eating.
- Elevating the head of the bed or using increased pillows. (Pillows should not be used for
infants)
Conclusion
Acid reflux, though common, can affect individuals of all ages, from infants to seniors. Understanding the causes, symptoms, and management strategies at each stage of life is essential for maintaining digestive health and preventing complications. If you or a loved one experiences persistent reflux symptoms, seeking medical advice and making appropriate lifestyle changes can help manage this condition effectively and improve overall quality of life.
Sources and Resources
Johns Hopkins
Cleveland Clinic
https://my.clevelandclinic.org/health/diseases/17019-acid-reflux-gerd
https://health.clevelandclinic.org/why-does-heartburn-get-worse-as-you-age/
https://my.clevelandclinic.org/health/treatments/4200-nissen-fundoplication
WebMD
https://www.webmd.com/heartburn-gerd/treating-heartburn-over-counter-medicine
Nutrition4Kids
https://nutrition4kids.com/articles/spitting-up-or-reflux-what-to-look-for/
https://nutrition4kids.com/articles/why-is-my-baby-spitting-up/
https://nutrition4kids.com/articles/warning-signs-of-reflux-gerd/
https://nutrition4kids.com/articles/tips-to-reduce-spitting-up/
https://nutrition4kids.com/articles/reflux-in-toddlers-and-older-children/
https://nutrition4kids.com/articles/reflux-common-in-obesity/
https://nutrition4kids.com/articles/6-things-every-parent-should-know-about-food-allergies/
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