Gastroesophageal Reflux in
 

Children and Adolescents
 

National Digestive Diseases Information Clearinghouse 

National 

Institute of 

Diabetes and 

Digestive 

and Kidney 

Diseases 

NATIONAL 

INSTITUTES 

OF HEALTH 

U.S. Department 

of Health and 

Human Services 

What is gastroesophageal 

reflux (GER)? 

Gastroesophageal reflux occurs when stomach contents reflux, or back up, into the 

esophagus during or after a meal. The 

esophagus is the tube that connects the 

mouth to the stomach. A ring of muscle at 

the bottom of the esophagus opens and closes to allow food to enter the stomach. This 

ring of muscle is called the lower esophageal 

sphincter (LES). Reflux can occur when the 

LES opens, allowing stomach contents and 

acid to come back up into the esophagus. 

GER often begins in infancy, but only a 

small number of infants continue to have 

GER as older children. 

What are the symptoms 

of GER? 

Almost all children and adults have a little 

bit of reflux, often without being aware of it. 

When refluxed material rapidly returns to 

the stomach, it does not harm the esophagus. 

However, in some children, the stomach contents remain in the esophagus and damage 

the esophageal lining. In other children, the 

stomach contents go up to the mouth and 

are swallowed again. When the refluxed 

material passes into the back of the mouth 

or enters the airways, the child may become 

hoarse, have a raspy voice, or a chronic 

cough. Other symptoms include 

• recurrent pneumonia 

• wheezing 

• difficult or painful swallowing 

• vomiting 

Digestive system noting the mouth, esophagus, lower 

esophageal sphincter (LES), stomach, and small 

intestine. 

• sore throat 

• weight loss 

• heartburn (in older children) 

How is GER diagnosed? 

You may want to visit an internist or a gastroenterologist. An internist specializes in 

internal medicine and a gastroenterologist 

treats diseases of the digestive system. The 

doctor can talk with you about your child’s 

symptoms, examine your child, and recommend tests to determine if reflux is the cause 

of the symptoms. These tests check the 

esophagus, stomach, and small intestine for 

problems. Sometimes a doctor will start 

treatment without running tests if the 

symptoms strongly indicate GER. 
The most common tests used to diagnose 

GER are the following: 

•	 Upper gastrointestinal (GI) series 

x ray. X rays are taken to check for 

damage to the esophagus, stomach, or 

intestines. First, a chalky drink called 

barium is swallowed, which makes the 

images on the x rays easier to see. A 

doctor cannot make a diagnosis of GER 

based on x rays alone, but x rays help 

rule out other problems that cause the 

same symptoms as GER. 

•	 Endoscopy. A sedative is given before 

this procedure to make the child sleepy. 

A small, flexible tube with a very tiny 

camera on the end is then inserted 

through the mouth and esophagus and 

into the stomach. The camera gives the 

doctor a view of the lining of the esophagus, stomach, and small intestine by 

transmitting the images onto a television 

screen. During the endoscopy, the 

doctor can also remove a small piece of 

tissue in a procedure called a biopsy. 

Looking at the tissue with a microscope 

helps the doctor determine the level of 

acid damage and rule out problems. 

Speak with your child’s health 

care provider if any of the 

following occur: 

• increased amounts of vomiting or persistent projectile (forceful) vomiting 

• vomiting fluid that is green or yellow or 

looks like coffee grounds or blood 

• difficulty breathing after vomiting or 

spitting up 

• pain related to eating 

• food refusal that causes weight loss or 

poor weight gain 

• difficult or painful swallowing 

•	 Esophageal pH probe. A thin, light 

wire with an acid sensor at its tip is 

inserted through the nose into the lower 

part of the esophagus. This probe 

detects and records the amount of 

stomach acid coming back up into the 

esophagus and indicates whether acid 

is in the esophagus when the child has 

symptoms such as crying, coughing, 

or arching her back. 

What is the treatment 

for GER? 

Treatment for reflux depends on the child’s 

symptoms and age. The doctor or nurse may 

first suggest a trial of medication to decrease 

the amount of acid made in the stomach 

when a child or teenager is uncomfortable, 

has difficulty sleeping or eating, or fails to 

grow. 

* H2-blockers, which are also called H2­

receptor agonists, are one class of medication often tried first. These drugs help keep 

acid from backing up into the esophagus. 

They are often used to treat children with 

GER because they come in liquid form. 

H2-blockers include 

•	 cimetidine (Tagamet) 

•	 ranitidine (Zantac) 

•	 famotidine (Pepcid) 

•	 nizatidine (Axid) 

A second class of medications often used to 

reduce stomach acid is proton-pump 

inhibitors (PPIs), which block the production 

of stomach acid. PPIs have few side effects, 

but those that have been reported are constipation, nausea, and headaches. This class of 

drugs includes 

• esomeprazole (Nexium)
 

• omeprazole (Prilosec)
 

•	 lansoprazole (Prevacid) 

•	 rabeprazole (Aciphex) 

•	 pantoprazole (Protonix) 

2 Gastroesophageal Reflux in Children and Adolescents 
A third class of medications used to treat 

GER is prokinetic agents. Prokinetic agents 

make the LES close tighter so stomach acid 

cannot reflux into the esophagus. These 

drugs are often used in combination with 

acid reducers. Prokinetic agents include 

•	 metoclopramide (Reglan) 

•	 cisapride (Propulsid) 

•	 erythromycin (Dispertab, Robimycin) 

•	 bethanechol (Duvoid, Urecholine) 

Serious side effects have been reported in 

adults and children taking metoclopramide 

and cisapride, including confusion, anxiety, 

diarrhea, and nausea. People taking prokinetic agents should tell their doctor if they 

are taking other medications because there 

could be an adverse drug reaction. 

Besides using medication, you may be able to 

reduce symptoms other ways. 

•	 Have your child eat more frequent
 

smaller meals.
 

•	 Have your child avoid eating 2 to 3
 

hours before bed.
 

•	 Raise the head of your child’s bed 6 to 8 

inches by putting blocks of wood under 

the bedposts. Just using extra pillows 

will not help. 

•	 Have your child avoid carbonated 

drinks, chocolate, caffeine, and foods 

that are high in fat or contain a lot of 

acid (citrus fruits) or spices. 

If the child continues to have symptoms 

despite initial treatment, tests may be 

ordered to help find better treatments. 

Surgery for GER in children is rare. However, surgery may be the best option for 

children who have severe symptoms that 

do not respond to medication. 

* The authors of this fact sheet do not specifically endorse 

the use of drugs for children that have not been tested in 

children (“off label” use). Such a determination can only 

be made under the recommendation of the treating 

health care provider. 

Points to Remember 

•	 GER occurs when stomach contents 

back up into the esophagus. 

•	 GER is common in infants, but most 

children grow out of it. 

•	 GER may cause vomiting, coughing, 

hoarseness, or painful swallowing. 

•	 Treatment depends on the child’s symptoms and age and may include changes 

in eating habits and taking medications. 

Surgery may be an option. 

If surgery is needed, a fundoplication will be 

performed. During a fundoplication the 

upper part of the stomach is wrapped around 

the LES. This procedure adds pressure to 

the lower end of the esophagus and reduces 

acid reflux. 

Your child’s doctor can discuss the treatment 

options with you to help your child feel well 

again. 

Hope Through Research 

The National Institute of Diabetes and 

Digestive and Kidney Diseases, through its 

Division of Digestive Diseases and Nutrition, 

supports basic and clinical research into 

gastrointestinal diseases. Researchers are 

studying the risk factors for developing GER 

and what causes the LES to open, with the 

aim of improving future treatment for GER. 

They are also studying the efficacy and safety 

of drug therapy for the treatment of GER in 

children and investigating the effectiveness 

of medications compared with surgery. 

The U.S. Government does not endorse or favor 

any specific commercial product or company. 

Trade, proprietary, or company names appearing 

in this document are used only because they are 

considered necessary in the context of the 

information provided. If a product is not 

mentioned, the omission does not mean or 

imply that the product is unsatisfactory. 

3 Gastroesophageal Reflux in Children and Adolescents 
National Digestive Diseases 

Information Clearinghouse 

2 Information Way 

Bethesda, MD 20892–3570 

Phone: 1–800–891–5389 

Fax: 703–738–4929 

Email: nddic@info.niddk.nih.gov 

Internet: www.digestive.niddk.nih.gov 

The National Digestive Diseases Information 

Clearinghouse (NDDIC) is a service of the 

National Institute of Diabetes and Digestive 

and Kidney Diseases (NIDDK). The NIDDK 

is part of the National Institutes of Health under 

the U.S. Department of Health and Human 

Services. Established in 1980, the Clearinghouse 

provides information about digestive diseases to 

people with digestive disorders and to their 

families, health care professionals, and the public. 

The NDDIC answers inquiries, develops and 

distributes publications, and works closely with 

professional and patient organizations and 

Government agencies to coordinate resources 

about digestive diseases. 

Publications produced by the Clearinghouse are 

carefully reviewed by both NIDDK scientists 

and outside experts. This fact sheet was 

reviewed by NASPGHAN. 

This publication is not copyrighted. The 

Clearinghouse encourages users of this fact 

sheet to duplicate and distribute as many 

copies as desired. 

This fact sheet is also available at 

www.digestive.niddk.nih.gov. 

For More Information 

North American Society for Pediatric 

Gastroenterology, Hepatology, and 

Nutrition (NASPGHAN) 

P.O. Box 6 

Flourtown, PA 19031 

Phone: 215–233–0808 

Fax: 215–233–3918 

Email: naspghan@naspghan.org 

Internet: www.NASPGHAN.org 

NASPGHAN’s Children’s Digestive Health 

and Nutrition Foundation (CDHNF) 

Internet: 	www.CDHNF.org 

www.KidsAcidReflux.org 

www.TeensAcidReflux.org 

This information was prepared in partnership 

with the North American Society for Pediatric Gastroenterology, Hepatology, and 

Nutrition (NASPGHAN), the Children’s 

Digestive Health and Nutrition Foundation 

(CDHNF), and the Association of Pediatric 

Gastroenterology and Nutrition Nurses 

(APGNN). The information is intended only 

to provide general information and not as a 

definitive basis for diagnosis or treatment 

in any particular case. You should consult 

your child’s doctor about your child’s specific 

condition. 

THE ASSOCIATION OF PEDIATRIC GASTROENTEROLOGY
 

AND NUTRITION NURSES
 

U.S. DEPARTMENT OF HEALTH 

AND HUMAN SERVICES 

National Institutes of Health 

NIH Publication No. 06–5418 

August 2006