Reflux in older children

Gastro-oesophageal reflux in older children and teenagers

This article is written by reflux parents for the benefit of reflux parents, based on their own experiences. It is not meant to replace medical advice and is of a general nature only. If you are worried that your child or teenager may be suffering from reflux, or you have any other questions or concerns, please seek advice from your medical professional.

While many children seem to improve throughout their first twelve to eighteen months, others continue to suffer from reflux beyond that, and there is increasing recognition that Gastro-oesophageal reflux can be an issue for older children and teenagers. While they may display characteristics seen in younger children, they may also display some of the characteristics listed here:

• Signs of reflux may change as infants and children get older. For some children, it can look as though their reflux is improving because their signs go away, but their signs may have changed instead (e.g. your child may no longer vomit but they can still be refluxing significantly.

• Even if a child seems to have outgrown reflux, parents sometimes report it recurs at times of stress (e.g. exams, starting school) or when reflux often flares e.g. teething, illness, vaccinations etc

• Children may verbalise how they feel, with complaints such as “My tummy/throat hurts”, “I feel sick”, “I have a yucky taste in my mouth”

• Children may have behavioural issues and may:
  • Be extremely sensitive
  • Cry easily or ‘lose the plot’ over very small issues
  • Be easily irritated or moody
  • Have temper tantrums (either extreme, or outside the expected age range)
  • Be demanding or clingy
  • Be aggressive, or display violent behaviour
  • Be impossible or difficult to reason with
  • Harm themselves (e.g. head banging, biting themselves, obsessive nail biting)

• Children may have eating issues and may:
  • Have food aversions, or sensitivities to different textures
  • Have difficulty or pain with swallowing
  • Refuse to eat. Some refuse breakfast but eat lunch (though some are the opposite and refuse meals later in the day)
  • Prefer to snack constantly rather than eat regular meals
  • Demand frequent drinks of water, and may even drink fluids in preference to eating

• Children may have sleeping issues such as:
  • Difficulty falling asleep
  • Being restless during sleep, or may cry, moan or swallow even while asleep
  • Teeth grinding while asleep
  • Not liking to lay flat
  • Wake tired and irritable
  • Asking for drinks of water overnight
  • Frequent night waking

• Children may:
  • Look pale
  • Clear their throat frequently
  • Have a hoarse or croaky voice, particularly on waking
  • Appear to be in pain (e.g. they may hold their tummy or double over)
  • Have motion sickness
  • Have dental erosion
  • Appear tired or lethargic
  • Burp frequently
  • Have sensory issues
  • Have difficulty concentrating or paying attention
  • Not necessarily aware of their reflux especially if its been an ongoing issue
  • Signs and symptoms may be worse after eating, lying down, participating in physical play/sport (running, jumping on the trampoline, playing games, swimming, gymnastics), laughing, bending over, or during periods of stress e.g. exams. Their signs and symptoms may appear suddenly or gradually and they may cough, choke or vomit at these times as well

• Therapies used to correct any issues e.g. behaviour, sleeping, eating, may be ineffective until the underlying cause is adequately addressed.
• “A recent practice-based survey that looked at the health of individuals between the ages of 3 to 17 years found that 1.8-8.2% experienced symptoms of GER. This study also showed that children were less likely to receive treatment for symptoms, probably because their parents/healthcare providers were not as aware of the frequency of events. When asked by the surveyor, children, especially younger children, were more likely to report symptoms of nausea, abdominal pain, and acid regurgitation than their parents reported… It is therefore important for health care providers to inquire about GERD during health care visits.“*

References

CDHNF. (2006, March 9). Reflux and GERD in Teens: Symptoms and Diagnosis. Retrieved May 29, 2012, from Children’s Digestive Health & Nutrition Foundation Available here

Franz, J. (2006). Gastroesophageal Reflux Disease. Retrieved August 8, 2010, from Gale Encyclopedia of Children’s Health: Infancy through Adolescence, from Encyclopedia.com Available here

Gillson, S. (2008, September 24). Gastroesophageal Reflux in Children. Retrieved August 8, 2010, from About.com: Heartburn/GERD Available here

Gremse, D. (2004, 5 5). GERD in the Pediatric Patient: Management Considerations. Retrieved 10 20, 2009, from Medscape Pediatrics Available here

Harnsberger, J. K. (2008). Management Algorithm #2: Management of a Child or Adolescent With Chronic Heartburn. Retrieved April 2, 2008, from Medscape Pediatrics Available here

Johnson, T., Burns, D., & Ziegler, J. (2010). Pediatric Dental Erosion and Extraesophageal Reflux Disease; A Case Presentation: Why Suspect EERD? Pediatric Nursing , 36 (1), 48-52. Available here

NDDIC. (2006, August). Gastroesophageal Reflux in Children and Adolescents. Retrieved March 28, 2008, from National Digestive Diseases Information Clearinghouse: Available here

Nelson, S. P. (2007, February 2). How Should the Management of GERD be Transitioned from Infant to Teenager? Retrieved August 2, 2010, from Medscape CME: Available here

Rosen, F. S., & Friedman, N. R. (2000, October 25). Pediatric Gastroesophageal Reflux. Retrieved March 20, 2008, from Dept. of Otolaryngology, University of Texas Medical Branch: Available here

* Sandritter, T. PharmD; “Gastroesophageal Reflux Disease in Infants and Children“; [Italicised quote] Journal of Pediatric Health Care. 2003;17(4)

Schwarz, S. M., & Hebra, A. (2008, Jan 18). Gastroesophageal Reflux. Retrieved March 24, 2008, from eMedicine: Available here