About Gastroesophageal Reflux Disease (GERD) in Infants and Adolescents

Gastroesophageal reflux disease, commonly referred to as GERD or acid reflux, is a chronic condition where the liquid content (acid, pepsin, and bile) of the stomach flows back into the esophagus. The esophagus, which is a tube connecting the mouth to the stomach, has a ring of muscle at the bottom known as the lower esophageal sphincter (LES). This ring of muscle is responsible for opening and closing allowing food to enter the stomach. Occasionally in infants and adolescents, when the LES opens, stomach contents back up into the esophagus causing the child to spit up and vomit. This constant regurgitation causes irritation to the lining of the esophagus and inflammation. Over time, the inflammation can erode or narrow the esophagus, causing bleeding, difficulty swallowing or even breathing. Other causes of GERD besides the improper functioning of the lower esophageal sphincter include hiatal hernias, esophageal contractions, and abnormal emptying of the stomach.

Common symptoms of Pediatric GERD include:

  • Frequent spitting up or vomiting (especially after meals)
  • Spitting up continuing after the first year of life (typically stops in most babies)
  • Refusing to eat or difficulty eating (choking or gagging)
  • Irritability or inconsolable crying during or after feeding
  • Heartburn, gas, or abdominal pain
  • Failure to gain weight
  • wet burps or wet hiccups

Gastroesophageal Reflux Disease (GERD) Treatment

If your child has been diagnosed with GERD there are a range of treatment options to consider. Treatment options depend on the type and severity of symptoms in your child.

In infants doctors sometimes recommend lightly thickening formula or breastmilk with rice cereal to reduce reflux. Your doctor may also recommend holding your infant upright during feedings.

For older children physicians may recommend avoiding certain foods and drinks that are known to trigger GERD symptoms such as:

  • spicy foods
  • citrus fruits
  • chocolate
  • tomato based food and sauces
  • garlic and onions
  • fatty and fried foods

If these precautionary measures do not alleviate the symptoms your physician may prescribe medications which can help reduce the production of stomach acid.

When medications fail and your child fails to grow or develops other complications of reflux, a surgical procedure known as Nissen Fundoplication may be recommended. Fundoplication is a surgical technique that helps strengthen the barrier to acid reflux when the sphincter is not functioning properly. During the procedure, the part of the stomach closest to the entry of the esophagus is gathered, wrapped, and sewn around the lower end of the esophagus and sphincter. This procedure increases the pressure at the lower end of the esophagus, thus reducing acid reflux.

There are various techniques available when performing a fundoplication including laparotomy, laparoscopic, and robotic-assisted. Here at the CARES Center our Pediatric Surgeons are on the leading edge of these surgical techniques and offer a Robotic Nissen Fundoplication. This technique requires only several small incisions in the abdomen versus the one large incision in a laparotomy. These smaller incisions have shown numerous benefits such as reduced post-operative pain, reduced blood loss, and reduced hospital stay. This allows our pediatric patients to recover faster and return to normal childhood activities.

Robotic Nissen Fundoplication – Is your child a candidate?

To learn more about Robotic Nissen Fundoplication and whether it is the right treatment option for your child, contact us or call us at (919) 843-7805.