Reflux in infants symptoms. The need for medical attention

Reflux in newborns is considered a natural process, quite understandable from the point of view of physiology, which in the vast majority of cases is successfully treated with nutritional correction. But in medicine there is still such a thing as reflux disease. Since both these states are similar to each other, it is necessary to arm yourself with knowledge in order to understand the difference between them.

Is reflux normal?

Gastroesophageal reflux is characterized by the backflow of gastric contents into the esophagus, and in some cases into the oral cavity. In infants, this content is represented by semi-curdled milk or an adapted mixture, depending on what the child eats. Since some acids can pass from the stomach into the esophagus, reflux is sometimes referred to as acid reflux.

According to statistics, 50% of children under 3 months of age spit up 1 to 4 times a day. The culmination of regurgitation in frequency falls on the 4th month of life. And having reached half a year, such excesses become less and less, completely disappearing by 1-1.5 years.

If spitting up is infrequent, the child eats enough in volume and gains weight normally, feels good - it is customary to talk about "uncomplicated" reflux, which does not require special treatment. How does it arise?

It's all about the structure of the gastrointestinal tract. In a newborn, the esophagus is shorter than in an adult, and the initial volume of the stomach does not exceed 30 ml. The stomach itself is still located horizontally, and the muscle located on the border with the esophagus (sphincter) is poorly developed. All these factors together contribute to the fact that a portion of milk that has entered during a meal often and almost unhindered comes back with active movements after eating or in a horizontal position.

During eating, food moves through the esophagus due to the process of peristalsis - special muscles, contracting and unclenching, create a kind of wave, pushing food to the stomach. Having reached the lower esophagus, food meets another obstacle - the esophageal sphincter. It resembles a muscular ring, a gate through which the contents pass further into the stomach. As soon as a portion of food has passed "customs", the sphincter closes tightly to prevent back reflux. Weakness of the muscle ring can be at any age, but in young children it occurs much more often.

Against the background of a weak sphincter, almost all babies spit up a small amount of milk 20-30 minutes after eating

Is baby crying related to reflux? There is no evidence that regurgitation causes pain. Discomfort, yes. However, sleep problems and increased irritability are not considered clinical symptoms of reflux. Therefore, look for the cause of crying in other areas: perhaps the child needs to change the diaper, feed him, or just caress him.

Reflux disease symptoms

When does reflux stop being harmless and people start talking about gastroesophageal reflux disease (GERD)? In the case when stomach acid enters the esophagus too often, which leads to irritation or damage. Symptoms of GERD:

• frequent and profuse regurgitation, often they gush;
• the child cries, refuses to eat;
• the baby arches the neck and back, thus trying to take a less painful position (Sandifer's syndrome);
• poor weight gain
• cough that is not the result of an infectious disease.

Causes

The prerequisites for the development of GERD are not only the weakening of the antireflux mechanism, the reflux of acids (hydrochloric and bile) and pepsin into the esophagus, but also various anomalies that occur in childhood:

• Pyloric stenosis is a pathological narrowing of the pylorus of the stomach, due to which the movement of food is difficult; accompanied by vomiting.
• Pylorospasm is a temporary contraction of the pylorus, which also delays the evacuation of food.
• Diaphragmatic hernia - displacement of the lower esophagus into the chest cavity through the opening of the diaphragm.

Spitting up isn't always harmless. The general condition of the child and the frequency of reflux manifestations will tell you when it is time to be examined to find the true cause of such conditions.

Diagnostics

There is no need to diagnose uncomplicated reflux in any special way. For the pediatrician, as well as for the parents, it is already obvious, regarded as a variant of the norm and does not cause concern.

If there are serious suspicions of gastroesophageal reflux disease, the child is referred for a consultation with a pediatric gastroenterologist. At the doctor's appointment, a detailed medical history is taken and a general physical examination is performed. Further, at the discretion of the doctor, the following examinations can be done:

1. X-ray examination. A contrast agent (barium) is injected into the gastrointestinal tract, and then its movement along the digestive tract is observed on the monitor screen.
2. Endoscopy. Thanks to this study, it is possible to assess the condition and color of the mucous membrane, whether there are edema in the folds of the esophagus or cardiac sphincter, whether the surface is eroded. If indicated, a biopsy is taken.
3. Sphincteromanometry. An examination to assess the tone of the lower esophageal sphincter.
4. pH test. Daily monitoring of acidity is carried out, thanks to which it is clear how many episodes of reflux occur per day and for how long. To do this, a probe with a special sensor at the end is inserted into the esophagus for 24 hours, which measures the level of acidity.
5. Examination of the stomach cavities. It is checked whether there is anything in the gastrointestinal tract that interferes with the movement of food and its timely evacuation.

Treatment

Treatment of simple cases, the main symptom of which is small regular regurgitation, is often limited to correcting the baby's lifestyle:

• experiment with eliminating cow's milk from the diet;
• protect the baby from inhaling tobacco smoke, which irritates the respiratory tract and provokes a cough;
• add special thickeners to food;
• review the diet of a nursing mother.

Principles of "safe" feeding

The first thing people pay attention to when spitting up is the style of eating. Is it possible that a caring mother is trying to feed her child “good and satisfying” even against his will? So, unfortunately, it happens.

Therefore, the first rule: feed in small volumes, but more often. In practice, this means that the baby must be taken from the breast 4-5 minutes earlier than usual or immediately, as soon as the baby begins to be distracted. If the basis of nutrition is adapted mixtures, then the volume of a separate portion is reduced by 10–20 ml, as recommended by the pediatrician.

If the child is already receiving complementary foods, but reflux still makes itself felt, the diet will focus on protein and carbohydrate foods in small portions. Juices and tomatoes are excluded from the diet

Second rule: no sudden movements and vertical position for half an hour after feeding. The well-known wearing of a column is simply necessary in the first 4 months of life if you want to minimize the frequency of spitting up. It is not necessary to walk around the room for 30 minutes, you can sit in a comfortable chair, while the baby calmly falls asleep on your shoulder in a semi-vertical position.

Only these two steps in 85% of cases can reduce reflux manifestations. But it happens that other changes are needed.

Diet food

According to studies, 15-36% of children who were diagnosed with gastroesophageal reflux disease had bovine milk protein intolerance.

Nutrition correction consists in the exclusion of dairy products from the diet of a breastfeeding mother. The experiment is carried out for 3 weeks. If during this time the baby's condition has improved, they talk about intolerance to milk protein and keep the diet until the child reaches 1 year.

In the case when the baby is bottle-fed, a dairy-free mixture based on protein hydrolyzate is selected: NutrilonPepti, Frisopep, Nutrilak peptidi SCT.

Thickeners

Today, the use of so-called antireflux mixtures plays an important role in diet therapy. These are special products for young children with increased viscosity, so that food stays longer in the stomach. In baby food, two types of thickener are used:

• Digestible (corn, rice, potato starch).
• Indigestible (gums).

Locust bean gum and other indigestible thickeners have not only an anti-reflux effect, but also a laxative effect. As an indigestible polysaccharide, gum reaches the colon unchanged and becomes a substrate for the growth of bifidus and lactobacilli. Compared to starches, gums have a more pronounced antireflux effect. Representatives of therapeutic mixtures: Humana Antireflux, Nutrilak AR Antireflux, Nutrilon Antireflux, Frisovoy. The same mixtures are recommended for children prone to constipation and intestinal colic.

If there is a need to use mixtures with thickeners, it is better to opt for those that have gum in their composition.

Mixtures in which starch is used as a thickener are considered softer in action. The effect of their use is noticeable after a month of taking. Representatives: Samper Lemolak, Nan Antireflux.

What if the newborn is breastfed? You shouldn't give up on it. The milk is expressed and a thickener purchased from a pharmacy is added to it, according to the recommendations from the manufacturer and the doctor.

It should be noted that the nipple on the bottle will have to be changed: the hole should be wide enough to let the thick mixture pass. A nipple "for cereals" is suitable.

Attention! All thickeners used to correct the nutrition of children under 3 months old, especially those prone to allergies, should only be prescribed by a doctor. They are practically not used as the only therapeutic component and are not recommended for children who have already developed esophagitis (inflammation or damage to the lining of the esophagus).

Medical treatment

In the case when all of the above measures are ineffective, a strategy for treatment with drugs of different pharmacological groups is developed. For informational purposes, here are examples of such drugs:

1. proton pump inhibitors. Means such as omeprazole, pantoprazole, block the last stage of the formation of hydrochloric acid, thereby reducing its production. As a rule, omeprazole is the gold standard in the treatment of GERD in children from 2 years of age.
2. Antacids. The purpose of antacids is also to neutralize hydrochloric acid. In pediatric practice, Phosphalugel, Maalox are used, which, in addition to their main function, have a restorative effect on the damaged mucosa.
3. Histamine H-2 blockers (ranitidine, famotidine). Treatment of children under one year of age rarely includes the use of these drugs.
4. Prokinetics (domperidone). Strengthen the motility of the stomach, thereby contributing to its rapid emptying and strengthening of the sphincter.

Drugs that reduce stomach acidity are selected by a doctor

Persistent regurgitation leads to dehydration and water-electrolyte imbalance. Very often, such losses can be restored only in a hospital by introducing infusion solutions.

All drugs have a number of side effects, as well as age restrictions. Therefore, their appointment must be fully justified. The doctor takes into account all the nuances and decides which groups of drugs are best suited.

Reason to call an ambulance

Reflux complicated by esophagitis must be treated. If your newborn has one or more of the following symptoms, get help right away:

• the child is rapidly losing body weight;
• daily, which is less than 3 months old, leads to starvation of the baby;
• categorical refusal to drink and eat during the day;
• blood in vomit or stool, severe diarrhea;
• the state of the baby is excessively depressed, inhibited;
• pneumonia develops.

So, reflux itself, or, as the people say, regurgitation, in infancy should not frighten parents, since it is understandable from the point of view of physiology and anatomy. Difficulties arise with frequent vomiting, when the acid in the esophagus becomes so much that it can cause damage to the mucosa - and this is associated with heartburn and pain for the baby. Then they talk about reflux disease.

On the other hand, pathological regurgitation is a reason to undergo a thorough examination in order to exclude the presence of concomitant serious diseases. The fact that the time has come for an examination will be prompted by parental intuition and the local pediatrician.

Gastroesophageal reflux(GER) is the backflow of stomach contents into the esophagus. GER can be in a child, both a normal phenomenon and a manifestation of the disease. In general, the concept of "reflux" means reverse casting. There is more than just the reflux of food from the stomach back into the esophagus. There is, for example, reflux in the pathology of the kidneys, when there is a reverse flow of urine from the ureter into the kidney, and in other diseases.

Gastroesophageal reflux is normal

Reflux is considered physiological when it occurs infrequently and briefly and is not accompanied by any unpleasant symptoms. For example, reflux can occur after eating a large, fatty meal.

Pathology occurs if refluxes are frequent and prolonged. Gastroesophageal reflux disease is always accompanied by inflammation of the esophagus (esophagitis). Human stomach contents are acidic (due to gastric juice). Systematically getting into the esophagus and contacting it for a long time, it causes its irritation and inflammation. Another name for gastroesophageal reflux disease is reflux esophagitis.

Damage to the esophagus can vary in extent and depth: from mild inflammation in the lower part of the esophagus to total esophagitis with ulceration. It depends on the duration of the disease, the frequency of refluxes and their intensity. Moreover, inflammation in the esophagus irritates the nerve endings located there and enhances GER. It turns out a kind of vicious circle: inflammation increases reflux, and reflux increases damage to the esophagus.

The correct passage of food through the esophagus to the stomach and beyond is achieved through the coordinated action of the organs (esophagus, stomach and diaphragm). Some mechanisms open the entrance to the stomach when it is required for the passage of food, while others close it if all the food has already arrived. The normal ratio of these mechanisms is provided by:
- regulating influence of the autonomic nervous system;
- adequate blood supply to this area;
- the correct anatomical structure of organs.

But it happens that under the influence of various factors, the action of the “closing” mechanisms weakens or, conversely, the activity of the “opening” ones increases. Then the food will go in the opposite direction, as nature does not provide for it.

Factors affecting the return of food from the stomach to the esophagus:

• Anatomical disorder.

Hernia of the esophagus.
- Short esophagus.
- Paralysis of the diaphragm, etc.

• Taking certain drugs, substances and products:

Theophylline, suprastin, seduxen, laxatives, hormones and other drugs;
- caffeine, chocolate, opiates, alcohol, tobacco.

• Dysregulation of the esophagus by the autonomic nervous system.

A well-known example: when you get sick in transport, nausea and vomiting occur.
- Stress, mental stress.

• Inflammatory processes in the stomach and duodenum (duodenal ulcer).
• Obesity.
• Violation of the diet (overeating, rare meals in large portions, plentiful meals at night).

Clinical manifestations of GER

• In infants, vomiting is also manifested.
• Dull aching pain in the epigastric region and behind the sternum.
• Pain intensifies immediately after eating and gradually subsides over the next 1.5-2 hours.
• Pain provokes weight lifting, brisk walking, running, deep bending.
• Heartburn. This is the main symptom. Children describe heartburn as "burning" or "burning" in the chest. Occurs on an empty stomach, after eating, with increased physical activity.
• Swallowing disorder.
• Belching of sour, air or food eaten.
• Hiccup.
• Nausea.
• Vomit.
• or seizures at night.

Diagnosis of GER

For the diagnosis of GER and reflux esophagitis in a child endoscopic examination of esophagogastroduodenoscopy (EGDS) is performed. Abbreviated at the household level, this study is called "gastroscopy".
Additionally, the acidity of gastric juice (pH of gastric juice) and its change during the day are examined.

Treatment of gastroesophageal reflux in a child

Physiological reflux treat not needed, only gastroesophageal reflux disease (reflux esophagitis).

Diet.

• Frequent (5-6 times a day) meals in small portions.
• Food should be mechanically well processed, should not be rough, too cold or hot, and irritate the sore esophagus. You can't eat dry food.
• The last meal is no later than 3-4 hours before bedtime. If you really want to eat - drink 1/2 cup of kefir at night or eat yogurt.
• With severe reflux, it is better to eat while standing.
• After eating, it is not recommended to lie down, sit. It is best to walk for 30-40 minutes.
• Within 2 hours after eating, it is not recommended to lean forward strongly, to actively engage in sports.
• Infants on artificial feeding are shown special therapeutic.
• Products excluded:

Provoking increased reflux: coffee, chocolate, fatty and spicy foods, citrus fruits, tomatoes.
- enhancing gas formation and bile separation: turnips, radishes, radishes, legumes, cabbage, cucumbers, eggplants, milk.

In modern conditions, the main enemies of the stomachs of our children: Cola (Pepsi-Cola, Coca-Cola, etc.), chips, McDonald's, instant noodles like Rolton, crackers (Emelya, Three crusts ”, etc.), mayonnaise, ketchup, alcohol (beer), tobacco smoke and chewing gum.

organizational moments.
Clothing. It is undesirable to wear clothes that tighten the waist and flatten the stomach (stretch trousers, tight elastic bands on shorts).
Dream. Sleep with a raised head end at 30-45 °. Better on stomach or right side.
Physical training. Preferably .
Not recommended:
- deep slopes
- weight lifting,
- exercises to strengthen the abdominal muscles,
- jumping,
- skis,
- bike.

Medical treatment.
Drugs that normalize the movement of food in the right direction (prokinetics): motilium, debridet, etc. They are very effective in reflux disease treatment. Take strictly as prescribed by the doctor, as some of them have undesirable side effects on the nervous system: agitation, insomnia, etc.

Drugs that reduce stomach acid. Antacids: maalox, megalac almasilat, almagel A, phospholugel. They contain aluminum and magnesium, which "quench" the acid. Children take these drugs from the age of 6 months as directed by a doctor 30-40 minutes before meals. You need to drink them slowly, swallowing, sitting at an angle of 45 °. With a tendency to it is better to use megalac.

Drugs that reduce the production of gastric juice by stomach cells: ranitidine, zantac, famotidine, gastrocepin, omez, losec. You can take drugs of this group only strictly according to the doctor's prescription, since some of them have a "rebound" syndrome: with a sharp cancellation, the symptoms of the disease intensify.

Restoring mucosa. To restore the mucosa and its speedy healing, the drug Venter is used.

Phytotherapy and folk recipes.
Herbs or herbal teas are changed every 2-3 weeks. After 2 months of taking herbs, take a break for 2-4 weeks. To achieve a lasting positive effect, herbs are treated for a long time, at least 6 months.

Infusion of oregano herb. Brew 15 g of grass with 200 ml of boiling water, leave for 40-60 minutes, strain, squeeze. Take 1 tbsp. l. 3 times a day.

A decoction of walnut leaves. Pour 10 g of raw materials with 200 ml of boiling water, boil in a water bath for 20-25 minutes, strain, squeeze. Take 1 tbsp. l. 3-4 times a day before meals.

A decoction of rhizomes and roots of burnet. Pour 6 g of crushed raw materials with 200 ml of boiling water, boil in a water bath for 15 minutes, strain, squeeze. Take 1 tbsp. l. 5-6 times a day after meals.

Violet herb infusion. Brew 20 g of grass with 200 ml of boiling water, leave for 40-60 minutes, strain, squeeze. Take 1 tbsp. l. 3 times a day.

Phytocollection No. 1:
mint leaves - 2 parts,
valerian rhizomes - 2 parts,
celandine grass - 1 part.
Pour 1 tbsp. l. chopped raw materials 1 cup boiling water. Boil in a water bath for 15 minutes. Cool, strain. Take warm, in small portions (through a straw), 5-6 times a day before meals.

Phytocollection No. 2:
thyme herb - 2 parts,
marshmallow root - 2 parts.
Pour 2 tbsp. l. chopped raw materials 1 cup boiling water. Infuse at room temperature for 2 hours. Boil on low heat for 5 minutes. Cool, strain. Take warm, in small portions (through a straw), 5-6 times a day before meals.

Phytocollection No. 3:
flax seed - 2 parts,
licorice root - 2 parts,
coltsfoot leaves - 2 parts.

Pour 1 tbsp. l. chopped raw materials 1 cup boiling water. Boil in a water bath for 15 minutes. Cool, strain. Take warm, in small portions (through a straw), 5-6 times a day before meals.

Honey. After taking honey, the acidity of the stomach normalizes, heartburn disappears, abdominal pain stops, erosions and ulcers heal. Treatment is possible only in the absence of an allergy to honey. Take 40 g (adult dose) of pure flower honey, dissolved in 1/3 cup of warm boiled water, 1.5-2 hours before meals or 3 hours after.

Surgery. When there are any anatomical defects (hiatal hernia, etc.) and if the GER is significantly pronounced and there is no effect from the treatment, they resort to surgery.

Prevention of GER

• Healthy lifestyle, rational mode of work and rest, gymnastics.
• Compliance with the rules of proper nutrition. Prevention of overeating and obesity.
• Timely detection and treatment of disorders of the autonomic nervous system, diseases of the stomach, duodenum.
• Protect the child from bad habits and explain the meaning of the harm of tobacco and alcohol.

The children's type of illness is a problem that all parents have to face to one degree or another. How to get rid of reflux in a child, find out right now!

Symptoms of reflux in children

The symptoms of the disease are:

regurgitation - in infants;

child's anxiety (crying, moodiness);

growth retardation of the baby (with frequent and / or profuse regurgitation);

an older child may complain of a burning sensation in the chest, bitterness in the mouth.

Early symptoms of the disease are manifested in the form of aching pain in the upper abdomen, which often intensifies after eating. There may also be attacks of bronchial asthma. Reflux in infants is characterized by frequent regurgitation, frequent vomiting, and poor weight gain.

Nonspecific signs of reflux in children

Nonspecific symptoms of the disease can be:

lack of appetite,

bad breath,

swallowing disorder,

frequent otitis.

Diagnosis of the disease in a child

The main diagnostic methods are esophagogastroduodenoscopy and X-ray contrast examination of the gastrointestinal tract.

• At the initial stage of reflux, erosion of the distal esophagus is noted,
• in the middle stage, foci of inflammation coalesce into a common area.
• At the final stage, inflammation captures the entire area of ​​​​the mucosa, and ulcers appear. At the fourth stage of reflux in a child, an esophageal ulcer, metaplasia of the esophageal mucosa (Barrett's esophagus), and stenosis are already clearly visible.

Features of the treatment of reflux in children

In infants, the disease usually resolves on its own by the age of one year against the background of the maturation of the gastrointestinal tract. If the attacks are frequent, plentiful, lead to a lag in physical development, then the pediatrician decides on drug therapy, the appointment of a specialized antireflux mixture, and an additional examination.

How to get rid of reflux in a child - useful tips

frequent small meals;

avoid reflux in children torso, lifting weights, jumping, especially after eating;

dinner no later than 3 hours before bedtime;

do not take a horizontal position immediately after eating;

do not wear tight belts;

limit the use of coffee, chocolate, fatty, spicy and fried foods, dried fish and dried fruits, carbonated drinks, chewing gum with reflux in children;

avoid smoking (including passive),

To get rid of reflux, it is useful for a child to chew gum - this increases the amount of saliva secreted, which is able to clear the esophagus from the formed gastric juice.

Many children experience heartburn, which can last for 2-4 hours. Such patients are advised to raise the head of the bed so that the head and shoulders are higher than the abdomen and do not allow gastric juice to burp into the esophagus.

The issue of prescribing medication is decided individually by the attending physician after receiving the results of the examination.

Medical treatment for reflux in children

In the treatment of acid reflux in mild children, medications are prescribed that are available without a doctor's prescription and contain antacids and histamine neutralizers, and a diet must also be followed.

Antacids are used for short-term and immediate elimination of the consequences of acid reflux. Gastric juice is neutralized after taking the drug for a short time and does not give a good effect. Antacids include tums maalokx, mulanta.

Histamine neutralizers reduce the percentage of juice produced in the stomach. They are not considered effective in neutralizing gastric juices, unlike proton pump inhibitors. Histamine preparations for the treatment of reflux in a child include drugs such as Ranitidine, Cimetidine, Nizatidine, Famotidine. These medicines are taken by mouth, one tablet twice a day, and can be bought at any pharmacy without a doctor's prescription.

Causes and prevention of childhood reflux

Often referred to as gastroesophageal reflux disease, reflux is a disorder that is associated with the constant reflux of stomach contents into the esophagus and is accompanied by inflammation of the esophagus (esophagitis). The causes of the disease are most often anatomical disorders in the area of ​​​​the transition of the stomach into the esophagus (this may be a hernia), a violation of the autonomic nervous regulation, an inflammatory process of the stomach (peptic ulcer, gastritis), a diet disorder (systematic overeating) and also taking certain medications.

Causes of Reflux in Babies

The causes of the disease can be:

immaturity of the digestive tract in infants;

improper feeding of the child (in this case, aerophagia occurs - swallowing a large amount of air during feeding);

overfeeding (too much milk from the mother);

congenital and acquired pathology of the digestive system.

Causes of illness in older children

Reflux in older children occurs against the background of chronic gastroduodenal pathology, which can be congenital (cardiac sphincter insufficiency) or acquired (gastritis, peptic ulcer). In any case, it is necessary to contact a specialist for the purpose of examination and, if necessary, the appointment of treatment for reflux.

A common cause of acid reflux in a child is food that relaxes the lower sphincter. High amounts of chocolate, caffeine, peppermint, high-fat foods on a child's menu can trigger acid reflux in many people. .

Prevention of childhood reflux

In order to prevent regurgitation in an infant, it is recommended:

frequent feeding with reflux in children in small portions;

before feeding, the child is laid out on his stomach, which contributes to the release of gases;

food for reflux in children should be thick;

use an elevated position when feeding to prevent reflux;

do not put pressure on the baby's tummy during feeding, do not use tight swaddling;

after eating, hold the child in a “column” for 20-30 minutes so that the air swallowed during the meal comes out;

during sleep, lay the child on its side.

To prevent the disease in older children, you should try to avoid late snacks and overeating.

Gastroesophageal reflux disease (GERD) is a chronic, relapsing pathology that occurs as a result of involuntary, arising for various reasons, reverse reflux of their contents from the stomach and duodenum into the lumen of the esophagus.

Gastroesophageal reflux, or reflux, is carried out due to the contraction of the muscles of the stomach wall. After birth, reflux allows the baby to get rid of air and excess food swallowed with food.

That is why reflux is a protective mechanism for babies: an excess amount of food could not be digested, fermented in the intestines and would cause bloating and pain. Swallowed air would create additional pressure in the stomach and would also cause pain in the baby. For this reason, reflux in newborns is a natural physiological mechanism and not a pathology.

From 4-5 months, the baby's digestive system is already more formed, the work of the sphincters, the motility of the digestive tract, and the function of the glands are normalized. So upon reaching the age of one year, reflux should no longer be. Only in the presence of developmental anomalies or provoking factors, gastroesophageal reflux persists until the cause is eliminated and is a pathology in these cases.

GERD is a fairly common pathology of the gastrointestinal tract in children. It affects 9-17% of the child population, regardless of the sex of the child. With age, the prevalence of the disease increases: if in children under five years old it is detected with a frequency of 0.9: 1000 children, then in the age group of 5-15 years, 23% of children suffer from it. Moreover, almost every third child develops complications, and in the long term, the occurrence of a malignant disease of the esophagus is not excluded.

The possibility of reflux from the stomach into the esophagus is due to the failure of the esophageal sphincter and impaired gastric motility. The sphincter is a muscle pulp that acts as a valve between the stomach and esophagus.

GERD is a consequence of the action of gastric juice on the mucous membrane in the lower 1/3 of the esophagus. Normally, the stomach is acidic (pH 1.5-2.0), and in the esophagus it is slightly alkaline or neutral (pH 6.0-7.7). When acidic contents enter the lumen of the esophagus, the mucosa is affected by chemical exposure.

Causes of GERD in children

Bad habits of the expectant mother, especially smoking, increase the risk of developing GERD in the baby.

The causes of the disease can be different - this is a polyetiological pathology:

1. In infants and preschool children, the occurrence of reflux disease is usually associated with a hereditary predisposition or anomalies in the development of the digestive organs (stomach deformity, short esophagus from birth, diaphragmatic hernia).

1. GERD in a child may be associated with bad habits of the mother during pregnancy and lactation (smoking, drinking alcohol), or dietary disorders.

1. The cause of reflux disease can be violations of the feeding regimen, the nature of the child's diet (overfeeding through the efforts of compassionate mothers and grandmothers, paratrophy and obesity).

1. Lack of parental attention to children can also become a risk factor for the development of GERD: the use by children (more often adolescents) of their favorite food - chips, sweets, carbonated drinks leads to dysfunction of the esophageal sphincter and other organs of the gastrointestinal tract.

1. In preschoolers, reflux disease can also be caused by prolonged sitting on the potty as a result of increased intra-abdominal pressure and weakening of the esophageal sphincter.

1. A provocative factor for the occurrence of GERD may be the use of certain medications (barbiturates, β-adrenergic receptors, anticholinergic nitrates, etc.).

1. Stressful situations affect the motility in the digestive organs, the release of hydrochloric acid. Negative emotions can provoke reflux of gastric contents into the esophagus.

Often, reflux disease is detected in diseases of the respiratory system (cystic fibrosis, bronchial asthma, often occurring bronchitis).

Classification

The classification of GERD in children is based on the degree of damage to the esophageal mucosa:

1. GERD without the development of esophagitis (inflammatory changes in the esophagus).
2. GERD with esophagitis is divided according to severity:

• I degree: the mucosa becomes loose with a local area of ​​redness;
• II degree: diffuse redness of the mucosa with fibrinous plaque in separate areas, erosions (shallow ulcers) may appear on the folds;
• III degree: characteristic is the defeat of the esophagus at its different levels with the appearance of multiple erosions;
• IV degree: a bleeding ulcer is formed, stenosis (narrowing) of the esophagus develops.

In addition, with reflux disease, there may be a violation of motility in the lower segment of the esophagus of 3 degrees: from a slight short-term dysfunction of the sphincter as a result of a prolapse of 1-2 cm (at grade A) to a long-term insufficiency of the sphincter as a result of a prolapse of 3 cm (at stage FROM).

Symptoms

All manifestations of reflux disease are divided into 2 groups:

1. Esophageal (associated with the digestive tract);
2. Extraesophageal (not associated with the digestive tract), which are divided into:

• cardiological;
• bronchopulmonary;
• dental;
• otolaryngological.

In children at an early age, the main manifestations of GERD are regurgitation or vomiting (in rare cases, with streaks of blood) and. Severe disorders of the respiratory system can occur up to respiratory arrest and sudden death.

Although it is difficult to identify this pathology in babies, such manifestations as regurgitation in the baby, anxiety and crying after feeding, belching with air, wheezing and coughing at night may indicate it.

At an older age, children are noted. The child may cry when eating, not knowing how to explain the resulting burning sensation. Often there is hiccups, nausea. Children may complain of chest pain when bending over after eating. In some babies, the reaction to burning and pain will be a grimace on the face, the child holds his hands on the place where the pain is located.

In adolescents, esophageal symptoms appear more clearly. The most common symptom (although not necessarily) is heartburn, resulting from the action of stomach contents (hydrochloric acid) on the lining in the esophagus. May be belching bitter or sour.

Quite often, the so-called “wet spot” symptom is noted: it appears on the pillow after sleep. Its appearance is associated with increased salivation due to impaired motility of the esophagus.

Swallowing disorders (dysphagia) are also characteristic, the manifestation of which will be pain in the retrosternal region during meals and a feeling of a lump in the chest. The hiccups that often occur in a child, although not a dangerous sign, should alert parents to reflux disease. Especially if a teenager is losing weight.

In some children, esophageal symptoms may be absent, and GERD is detected only during the examination. And it may be the other way around: the manifestations are obvious, but endoscopy does not reveal signs of the disease.

With the development of a bleeding ulcer, symptoms of anemia, dizziness, severe weakness, pallor of the skin and mucous membranes are noted, fainting, etc.

Regardless of age, GERD may present with:

• headache;
• weather dependence;
• emotional lability (nervous, aggressive behavior, causeless depression, etc.);
• insomnia.

Extraesophageal symptoms:

1. Bronchopulmonary signs accompany reflux disease most often (about 80%). They are characterized by an obstructive syndrome, the appearance of shortness of breath or an attack of coughing at night and after eating. They can be combined with heartburn, belching. Children often have bronchial asthma. Bronchopulmonary symptoms decrease or even disappear with the treatment of reflux disease.

1. Cardiac symptoms can be cardiac arrhythmias in the form of various arrhythmias, ECG changes.

1. Otolaryngological signs: sore throat, hoarseness, sensation of food stuck in the throat, feeling of pressure in the chest or neck, pain in the ears.

1. A dental sign of GERD is damage to the enamel on the teeth in the form of erosions (as a result of the action of hydrochloric acid thrown from the stomach).

Complications of GERD in children

GERD can lead to erosions in the esophagus that bleed continuously and cause anemia.

In the absence of adequate treatment of reflux disease, it can lead to such complications:

1. Stenosis, or narrowed lumen of the esophagus, associated with scarring of ulcers and erosions of the mucosa. The tissues around the esophagus are involved in the inflammatory process, and periesophagitis occurs.

1. , which is a consequence of prolonged bleeding of erosions in the esophagus or infringement of a diaphragmatic hernia. Characteristics of anemia in GERD: normocytic, normochromic, normoregenerative. In this case, the level of iron in the blood serum may decrease slightly.

1. Barrett's esophagus: squamous stratified epithelium of the esophageal mucosa is replaced by a columnar one. It is considered a precancerous disease. It is detected in 6-14% of patients. Malignancy almost always occurs - squamous cell carcinoma or adenocarcinoma of the esophagus develops.

Diagnostics

Diagnosis of GERD in children is based on clinical manifestations, research results (laboratory and instrumental). During the survey, the doctor reveals the presence of typical manifestations of the disease. Examination of the child is usually uninformative.

A blood test can detect (in the case of anemia) a decrease in hemoglobin and red blood cell count.

Instrumental research methods:

1. Intraesophageal pH-metry during 24-hour monitoring makes it possible to detect incompetence of the esophageal sphincter (gastroesophageal reflux), to assess mucosal damage - the technique is not accidentally called the gold standard in the diagnosis of GERD. Data on changes in acidity in the esophagus are decisive for confirming the diagnosis of reflux disease. The method is used at any age of the child.

1. Fibrogastroduodenoscopy is mandatory if reflux disease is suspected. Endoscopic equipment allows you to identify esophagitis (inflammation of the esophagus) and determine the degree of it and impaired motility of the esophagus. During the procedure, it is possible to take biopsy material in case of a suspected complication in the form of Barrett's esophagus.

1. X-ray examination with the use of contrast allows you to confirm the presence of gastroduodenal reflux and identify the pathology of the digestive tract, which was the cause of GERD or its consequence (impaired evacuation function of the stomach, esophageal stenosis, diaphragmatic hernia).

Treatment of GERD in children

Depending on the age, severity of reflux disease, the following methods can be used to treat it in children:

• non-drug treatment;
• drug therapy;
• surgical correction.

Children of the younger age group are treated non-pharmacologically with the help of postural therapy and nutritional correction. Postural therapy is treatment by changing the position of the body. To reduce gastroesophageal reflux and reduce the risk of developing esophagitis, it is recommended to breastfeed the baby while sitting at an angle of 50-60 0.

Children cannot be overfed. After feeding, the child needs at least 20-30 minutes. maintain a vertical position. During sleep, you should also create a special raised (by 15-20 cm) position of the head and upper body for the baby.

To correct nutrition, only as directed by a pediatrician, you can use mixtures with anti-reflux properties (Nutrilak AR, Humana AR, Nutrilon AR), which help thicken food and reduce the number of refluxes.

For older children, the GERD diet recommends:

• frequent meals in fractional portions;
• increase in proteins in the diet, decrease in fats;
• exclusion of fatty foods, fried foods, spicy foods;
• prohibition of the use of carbonated drinks;
• restriction of sweets;
• maintain a vertical position after eating for at least half an hour;
• prohibition of sports after eating;
• eating no later than 3 hours before bedtime.

It is important to exclude constipation in a child and other factors that cause increased intra-abdominal pressure. If possible, the use of medications that provoke reflux should be avoided. When a child needs to develop measures to normalize weight with a pediatrician.

The need for medical treatment is determined and selected by the doctor depending on the severity of the disease.

Drugs from the following groups can be used:

• proton pump blockers - drugs that reduce the synthesis of hydrochloric acid by the glands of the gastric mucosa, relieving heartburn (Rabeprazole);
• normalizers of gastrointestinal motility by affecting the muscles in the digestive organs (Trimebutin);
• prokinetics that stimulate gastrointestinal motility (Domperidone, Motilium, Motilak);
• antacids that neutralize hydrochloric acid (Phosphalugel, Maalox, Almagel).

Depending on the accompanying pathological changes, symptomatic treatment is also carried out.

Indications for surgical correction (fundoplication) are:

• anomalies in the development of the digestive system;
• severe course of GERD;
• failure of conservative treatment;
• combination of reflux disease with diaphragmatic hernia;
• development of complications.

In many clinics, the operation is performed by a less traumatic laparoscopic method.

Forecast

The need to treat GERD with medications is assessed by the doctor, depending on the severity of the disease.

Most children with GERD have a good prognosis. In the event of a complication in the form of Barrett's esophagus, there is an increased risk of malignancy. Although in childhood a malignant tumor develops in very rare cases, in the future every third patient will be diagnosed with esophageal cancer within 50 years.

Prevention of GERD

To reduce the risk of developing reflux disease, all factors contributing to its occurrence should be excluded. The most important preventive measures are:

• providing proper nutrition to the child;
• exclusion of causes that increase intra-abdominal pressure;
• limiting the use of reflux-provoking medications.

Summary for parents

The main manifestations of reflux disease are belching, heartburn, a feeling of a lump in the chest. It is impossible to ignore the "burning" problem in a child. The disease can lead to disruption of the respiratory and cardiovascular systems, the formation of bleeding ulcers and anemia.

If you find a wet spot on the pillow and other manifestations, you should contact your pediatrician or pediatric gastroenterologist and conduct an examination to determine the cause of GERD. If necessary, conduct adequate treatment to prevent the development of complications.

Health-saving channel, doctor of the highest category Vasilchenko I.V. talks about GERD in children:

Reflux in children is a specific pathology in which the contents of the stomach begin to move back into the esophagus. It is reflux that is the main cause of regurgitation and frequent vomiting.

The main cause of the disorder is the dysfunction of the lower sphincter, if this organ is compressed and unclenched out of time, there is an increased likelihood that the incoming food will be transmitted higher into the esophagus.

Provoking factors

Reflux development

Experts say that reflux in infants most often develops due to an excessive amount of food in the stomach.

It must be understood that in newborns, the muscles of all organs, including the stomach and esophagus, are too weak, they simply cannot cope with their functions.

If the stomach is full, it will try in every possible way to get rid of excess products, and will begin to transfer them back to the esophagus. Another common cause of reflux in babies is an allergy to certain foods or a small esophagus.

In older children, pathology often occurs due to such disorders:

• acute or chronic gastritis;
• insufficiency of the cardiac sphincter;
• problems with the nervous system;
• hiatal hernia;
• the presence of excess weight;
• paralysis of the diaphragm;
• stomach ulcer.

Experts also warn parents that excessive consumption of various sweets - sweets, chocolate, buns, jam, marshmallows, as well as foods high in fat can also provoke gastroesophageal reflux.

The results of excessive consumption of sweets can be deplorable.

Symptoms of the disease

Gastroesophageal reflux disease is always accompanied by the same symptoms, regardless of what form and degree of pathology the patient has encountered. In international medicine today, physicians distinguish two forms of this disease.

Acute - the disease is accompanied by an increase in body temperature, the appearance of pain in the chest and increased salivation. With this form, the patient experiences severe discomfort when swallowing food and a burning sensation in the esophagus.

Chronic. If reflux is not treated on time, it will become chronic. It is impossible to cure the disease at this stage, it will entail not only the occurrence of painful sensations, but also provoke breathing difficulties and cause constant vomiting.

Abdominal pain in a child with reflux

Additionally, reflux in children and adults is often catarrhal and erosive. In the catarrhal form, inflammation occurs only on the surface of the mucous membranes, but does not destroy soft tissues.

In the erosive form, small erosive lesions form on the mucosa of the esophagus, provoking a degenerative process. With erosive reflux, the symptoms will be pronounced, the patient will experience discomfort and pain most of the time.

Reflux in children and adults has 1, 2 and 3 degrees, depending on how many mucous tissues are affected by ulcerative neoplasms.

The manifestation of reflux in children

Doctors warn that in order for the treatment of the disease to be successful, it is necessary to start fighting it at the initial stage. That is why every parent should be aware of the signs of reflux in children:

• regurgitation;
• babies 3-5 years old complain of a bitter taste in the mouth;
• the occurrence of burning and tingling in the chest;
• slight delay in development.

But at the initial stage, pain and discomfort will occur only after eating.

Diagnosis of the disease in children

If the symptoms of reflux in infants, which is complicated by esophagitis, do not disappear within 5-7 days, but at the same time increase, it is recommended to immediately sign up for an examination with a doctor.

To accurately identify the clinical picture, the physician will not only take an anamnesis and physical examination of a small patient, but also prescribe examinations and tests.

X-ray - it is carried out using barium sulfate - a special contrast agent.

Esophagogastroduodenoscopy is a popular type of endoscopic examination, it gives the physician the opportunity to visually assess the condition of the esophagus and stomach cavities.

ph test - this test is rather unpleasant, as it is carried out using a tube with a probe, at the end of which there is a tiny camera.

Only after the doctor is sure that the child has encountered esophagus reflux, parents will be able to select the treatment.

When is medical intervention required?

The danger of reflux in children is that many parents confuse this disease with other disorders and begin self-medication at home.

Because of such unreasonable actions, the disease begins to develop, and the baby's condition only worsens. Experts warn that in order to avoid complications, the child must be shown to the doctor, after the diagnosis, the specialist will select the optimal method of treatment.

It is especially important to do this when the following symptoms appear:

• the child complains of difficulty swallowing food;
• fecal masses have acquired a dark shade;
• there are streaks of blood in the vomit;
• prolonged hiccups;
• the baby has a fever and does not fall for more than 3 days.

Seek medical attention if symptoms occur

Especially parents should be alerted by the factor if the baby eats, but at the same time gradually loses weight.

Causes of reflux in babies

Doctors note that reflux in newborns most often occurs due to initial anatomical disorders in the esophagus or stomach, and it can also be a consequence of autonomic nervous regulation dysfunction.

Among the common causes of childhood reflux, doctors distinguish the following symptoms:

• Problems with the formation of the digestive tract.
• If parents hold the spoon incorrectly or feed the baby in the wrong position, food will enter the stomach with more air, causing aerophagia.
• Overfeeding.
• Acquired pathologies of the digestive system.

Causes of illness in preschool children

Gastritis as one of the causes of reflux

Reflux in children after 6–7 years of age often develops when gastroduodenal pathologies appear, such as gastritis, an ulcer, or underdevelopment of the sphincter.

In order to accurately identify what caused the disease and choose a competent treatment method, you will need to make an appointment with a specialist and undergo an examination. As practice shows, quite often acid reflux occurs due to excessive consumption of products that relax the lower sphincter - all kinds of sweets and foods high in fat.

Reflux Treatment

The method of treatment will be selected depending on the form and stage of reflux. Most often, modern medications are chosen as the main therapy, but if the disease is neglected, surgical intervention will be the only way out. To combat reflux, drugs of several pharmaceutical groups are most often prescribed.

Antisecretory drugs - their main purpose is to reduce acid in the gastric juice, but they also help reduce heartburn and relieve irritation from the walls of the esophagus.

Omeprazole and Famotidine are considered popular and effective drugs in this category. It is important to remember that the drugs are very active, so only a physician should select their dosage and duration of the course of treatment.

Prokinetics increase the tone of the sphincter esophagus. Most often, doctors prescribe Domidon and Motilium for the treatment of babies.

Histamine neutralizers reduce the percentage of gastric juice production.

Antacids neutralize the action of hydrochloric acid in gastric juice, especially with an excess of the substance. Medicines of this group are prescribed only to those babies whose age is more than 4 years. Known medicines are Rennie, Maalox and Almagel.

It must be understood that all these drugs can cause various side effects, so treatment should be carried out very carefully.

Pathology prevention method

The following measures will help prevent reflux in infants and save the baby from unpleasant consequences:

• So that the baby is not hungry, it is better 5-6 times a day, but the portions should be small.
• Before starting feeding, the baby should be put on the tummy for 5 minutes, this contributes to the release of gases.
• The child needs to be fed only in a sitting position, and in a horizontal position it is forbidden.
• In order for food to be properly distributed and assimilated, during feeding, the baby needs to loosen swaddling.
• After the child has eaten, he must be held upright for about 20 minutes, this will help the absorbed air to come out.

One of the methods of preventing the disease, laying the baby on his stomach before feeding

If the baby has the initial stage of reflux, it is recommended to feed him only thick food. Despite the fact that the prevention of childhood reflux is not difficult, it is really very effective and helps to prevent the onset of the disease.

Features of surgical intervention

Surgical treatment is prescribed very rarely, doctors resort to it only in cases where drug treatment is ineffective and does not bring improvements for a long time.

Experts assure that the operation for reflux most often takes place without any complications, its main task is to restore the anatomical function of the esophagus. But it must be remembered that the process is in any case quite risky, so before agreeing to such a decision, you need to think it over carefully.

Childhood reflux is a rather unpleasant and dangerous disease. That is why parents should constantly monitor their baby, and in case of frequent regurgitation and vomiting, immediately consult an experienced pediatrician.

Video: Gastroesophageal reflux disease in children

It's important to know! An effective remedy for gastritis and stomach ulcers exists! To be cured in 1 week, just enough ...

Diseases of the digestive system overtake not only adults, but also children. Sometimes they can appear due to an unhealthy diet, and sometimes due to the characteristics of the organism itself. One of these diseases is reflux esophagitis in children: the symptoms and treatment of this disease will be discussed in detail in this article.

Its other names are gastroesophageal reflux, gastroesophageal reflux disease (GERD), gastroesophageal reflux, acid reflux. In children, this disease can develop even up to a year.

Reflux esophagitis: what is it in children

Gastroesophageal reflux is an inflammatory process that occurs due to the release of stomach contents into the esophagus. The body uses hydrochloric acid to digest food. If the gastric mucosa can withstand such a level of acidity, then the esophageal mucosa begins to be injured when exposed to hydrochloric acid.

When food enters the esophagus, it redirects it to the stomach with soft wave-like movements of its walls. There is a lower esophageal sphincter between the esophagus and stomach. It is a muscular ring that must open in time to allow food to enter the stomach.

Another function of the lower food sphincter is the timely closure of this opening. When the sphincter is poorly closed, gastric juices and acids enter the esophagus along with digested food.

Reflux esophagitis can also appear in healthy children. This process can be short-term, so the baby will not even feel any negative symptoms.

If this situation is repeatedly repeated and causes the baby to feel unwell, then this problem must be dealt with already with medical help.

Gastroesophageal reflux: symptoms in children

If in adults the symptoms of this disease are quite similar, then in children of different ages reflux esophagitis can manifest itself in very different ways. Parents should observe the change in the behavior of the crumbs and his health, since symptoms will help determine the presence of this disease.

Symptoms of a disease such as reflux esophagitis in a child under 5 years of age are as follows:

• an unpleasant bitter-sour taste or smell in the child's mouth;
• vomit;
• lack of appetite, as pain appears after each meal;
• weight loss of the child;
• pain in the center of the chest;
• shortness of breath (this symptom is pronounced in children with asthma).

Symptoms of a disease such as gastroesophageal reflux in an older child and adolescents are much easier to determine, since children themselves can characterize their pain or discomfort.

Often GERD at this age manifests itself in the form of:

Babies up to a year old can be naughty, refuse food, often hiccup after eating, show or stroke the sternum. The pain may worsen even during sleep. The baby may feel soreness or burning immediately after eating if he is immediately put to bed after feeding.

Reflux esophagitis in a child: Dr. Komarovsky

Doctor Komarovsky considers gastroesophageal reflux in infants, as well as in children under one year old, to be a common physiological phenomenon. At this age, the baby's body has not yet fully formed the distal esophagus, which would retain the contents of the stomach. In addition, at this age, the volume of the stomach is relatively small, and its shape is round. All this provokes regurgitation and vomiting after eating. Such symptoms occur spontaneously and abruptly.

Over time, when solid food is introduced into the diet, such reactions of the body should stop. The antireflux barrier is fully developed, which prevents gastric contents from entering the esophagus.

In older children, this disease can develop for various reasons:

1. Due to excessive and frequent consumption of food. Parents can overfeed the baby, and sometimes he accustoms himself to large amounts of food.
2. Excess production of hydrochloric acid. Also for this reason, pyrolospasm and gastrostasis can develop.
3. After eating, the baby immediately assumes a horizontal position.
4. Increased intragastric pressure. This may be due to wearing tight clothing, a belt, or drinking a lot of carbonated drinks.

All of the above reasons provoke different symptoms in children.

Dr. Komarovsky notes that parents should pay special attention to symptoms that appear in the morning and immediately after eating.

With esophageal gastric reflux in children, the following may appear:

• constipation;
• hiccups
• cough immediately after waking up;
• belching after eating;
• bitter smell from the mouth;
• snoring during sleep;
• deterioration of tooth enamel;
• heartburn;
• chest pain;
• regurgitation.

Special attention should be paid to non-food symptoms of reflux. In some cases, this disease can cause frequent otitis, laryngitis and pharyngitis.

Important! The pain in this disease begins to intensify with a horizontal position. In adolescents, this disease can be confused with cardiac angina. But you should not panic, because after taking antacids, the pain in the sternum should go away.

The appointment of drugs that reduce the secretion of gastric juice should only gastroenterologist or pediatrician. Self-medication in this matter can only worsen the situation. The doctor prescribes the exact dosage of the drug, taking into account the age of the child and the stage of development of the disease.

Reflux esophagitis in children 1 year old

The principle of the appearance of reflux in children under one year old is based on the underdevelopment of the food sphincter, so food is quickly redirected in the opposite direction along the esophagus. With age, this area is completely formed, which leads to a decrease in the frequency of regurgitation after feeding.

Scientists have conducted studies that have determined:

These statistics help to understand the frequency and likelihood of developing reflux at this age. If acid reflux has an uncomplicated form, then in infants up to three months a day, at least one regurgitation occurs. When such symptoms do not go away in children after a year, or, on the contrary, it becomes more frequent, then the baby should be shown to the pediatrician.

Symptoms of reflux in one-year-old children:

• arching of the back or neck from pain;
• fountain vomiting;
• slight weight gain
• refusal to feed;
• crying after and before eating.

If reflux was diagnosed in the early stages, then such a disease can be cured with conservative methods.

Gastroesophageal reflux in children: treatment

If diagnosed with gastroesophageal reflux disease, how to treat and what to do? If the reflux is uncomplicated, then the baby can be cured with a simple change in diet. To do this, doctors recommend taking the following measures:

These are four recommendations that will help the stomach process food faster without irritating the lining of the esophagus. Often parents do not understand how the refusal of milk can affect the development of reflux, because babies under the age of one are still breastfed.

The fact is that milk contains protein, which some children do not digest. This condition is called dietary protein-induced gastroenteropathy.

Important! Often, this disease persists in children under one year old, so nursing mothers need to stop consuming dairy and soy products. If after a year milk protein intolerance persists, then the diet should be extended. In this case, it is better to show the child to the doctor.

Food thickeners

These substances help to make food more dense, so it is easier for the child to get enough faster. Due to the thick consistency, food will not quickly flow from the stomach into the esophagus.

As such substances are used: corn, potato and rice starch, carob flour. American scientists have determined that no more than 1 tablespoon of thickener per 30 ml of liquid can be introduced into the food of a child who is from 0 to 3 months old.

You need to add a thickener to expressed breast milk in the same way, but at the same time, the hole in the bottle needs to be done more so that it is easier for the baby to suck food.

The nuances of the position of the baby's body at the time of feeding

To prevent liquid food from returning from the stomach to the esophagus, you need to feed the baby in an upright position. In addition, after eating, the baby should be carried in her arms so that her head rests on the parent's shoulder. In this position, the child should be in a state of physical and emotional rest. You can not overfeed the baby, as his stomach is still small in volume.

Important! As soon as the baby begins to stubbornly lose interest in food, you need to stop feeding.

If conservative methods of treatment do not help, then the doctor may prescribe medication. It is based on drugs that reduce the acidity of gastric juice.

There are four main principles of conservative treatment of this disease, namely:

• healthy and moderate nutrition (eat at least 5 times a day, do not eat 3 hours before bedtime, drink more water, reduce the intake of sweet and fatty foods);
• decrease in the production of gastric juice due to the intake of adsorbents and antacids (" Gaviscon»);
• taking prokinetics that stimulate the motor-evacuation function of the stomach, (" Cerucal»);
• the appointment of drugs that reduce the negative effect of acid on the esophagus (" Ranitidine», « Fanitidin»).

Not always all of these drugs can help the child, because sometimes they can cause side effects. It is contraindicated to give the child these drugs on their own.

Useful video: gastroesophageal reflux disease in children

In what cases is it necessary to urgently contact a pediatrician or gastroenterologist?

If children of the older age group can be asked in detail about the characteristics of pain, then children from 1 to 3 years old often cannot tell about their condition.

Parents need to remember a number of symptoms that should alert, namely:

• recurring pneumonia in a child;
• weight gain or weight loss;
• prolonged crying of the baby, which does not stop even after 1-2 hours;
• the baby flatly refuses any food and water intake;
• fountain regurgitation of food in children under 3 months;
• severe irritability in behavior;
• blood-streaked stool;
• frequent diarrhea;
• recurring vomiting.

Such complications are the result of advanced esophageal reflux, so it is better to seek help from a pediatrician immediately after the slightest change in the child's behavior. Of course, we are talking about a persistent change in the baby's appetite, a decrease or stop in weight, frequent vomiting, and general weakness of the body.

Gastroesophageal reflux disease in children, the symptoms of which are described above, is a condition that up to a certain age of the child may be the norm.

With timely diagnosis, such inflammation of the esophagus can be cured even without medical assistance. The main thing is to notice changes in the behavior of the baby in time.

Find a free gastroenterologist in your city online:

Gastroesophageal (gastroesophageal) reflux refers to the return of food eaten and stomach acid back into the esophagus. Due to the unformed digestive system in infants, this phenomenon occurs constantly and does not pose a danger to the health of the baby. The state reaches its peak at the age of 4 months, gradually fading away by the 6-7th month from birth and completely disappearing by 1-1.5 years.

In a newborn child, the esophagus is anatomically short, and the valve that blocks the passage of food back from the stomach is poorly developed. This results in frequent regurgitation of milk or adapted formula, depending on the type of feeding.

Gastroesophageal reflux is a natural physiological process in infants that promotes the removal of air that has entered the stomach during meals. The small size of the stomach in newborns also leads to regurgitation. The process should not cause concern to parents while the baby's condition is within the normal range.

Causes of Reflux

Physiological reflux in children occurs due to an undeveloped digestive system and the baby's lying position after eating. Overeating and long-term use of anti-inflammatory drugs by the child only exacerbates the manifestations of this condition. The manifestations of gastroesophageal reflux are especially painful during active movements, turns and tilts, which is why it is so important to remain calm after eating.

Causes of pathological reflux disease in children include:

• congenital anomalies of the digestive system;
• entry of bile into the stomach due to deformations of the gallbladder;
• hernia of the diaphragm;
• the presence of allergies;
• lactase deficiency;
• premature birth;
• damage to the spine in the cervical region.

Types of reflux

According to the degree of complexity, there are:

1. Uncomplicated reflux is a natural condition for the child's body, passing with age and as the digestive organs form. The frequency of regurgitation with him is 1-4 times a day, the baby is stable in weight and his health does not suffer.
2. Complicated reflux leading to esophagitis (inflammation of the esophagus) or reflux disease requires treatment. The onset of the disease can be suspected by frequent vomiting, weight loss, refusal to eat, forced position of the back and neck. Pathological gastroesophageal reflux is also manifested by cough in the absence of respiratory tract infections.

According to the predominant contents thrown into the esophagus, refluxes are distinguished:

1. Alkaline, in which substances are thrown from the stomach and intestines with an admixture of bile and lysolecithin, the acidity in this case exceeds 7%.
2. Acidic - contributes to the entry of hydrochloric acid into the esophagus, lowering its acidity to 4%.
3. Low acid - leads to acidity from 4 to 7%.

Symptoms of gastroesophageal reflux

In addition to heartburn and regurgitation, reflux in a child is often disguised as symptoms of diseases of other organs and systems:

1. Digestive disorders: vomiting, pain in the upper part of the stomach, constipation.
2. Inflammation of the respiratory system. The reflux of gastric contents is sometimes not limited to the esophagus and passes further into the pharynx, getting from there into the respiratory tract. It causes:

• Cough, mainly at night, sore throat, hoarse crying in infants.
• Otitis (inflammation of the ear).
• Chronic pneumonia, non-infectious bronchial asthma.

1. Diseases of the teeth. This is caused by the fact that acidic gastric juice corrodes tooth enamel, leading to the rapid development of caries and tooth decay.
2. Cardiovascular disorders: arrhythmia, chest pain in the region of the heart.

Treatment of gastroesophageal reflux

An uncomplicated type of condition does not need medication, it is enough to adjust the diet and feeding habits of the child.

1. Feed your baby more often, but in smaller portions.
2. In case of allergies, exclude cow's milk proteins from the diet of newborns and nursing mothers. Use for feeding special mixtures that do not contain milk proteins, such as Frisopep, Nutrilon Pepti. The effect is more often achieved after three weeks of following this diet.
3. Add thickeners to the diet or use ready-made anti-reflux mixtures. They contain substances that inhibit the reverse flow of food into the esophagus. This type of food includes locust bean gum or starch (potato, corn). Mixtures where gum acts as a thickener - Nutrilak, Humana Antireflux, Frisovoy, Nutrilon; starch thickener is present in baby food brands NAN and Samper Lemolak. If the baby is breastfed, a thickener is added to the expressed milk, which can be bought at a pharmacy. Children older than 2 months are allowed to give a teaspoon of rice porridge without milk before feeding, which helps to thicken the food eaten.
4. After feeding, ensure the baby stays upright for at least 20 minutes. For infants, wearing a column immediately after eating is suitable.

In the absence of the effect of such measures, the use of drugs will be required.

• Antacids (Maalox, Phosphalugel), enzymes (Protonix) are used to neutralize gastric acid and reduce its harm to the esophageal mucosa.
• To speed up digestion and strengthen the esophageal sphincter, drugs Raglan, Propulsid have been developed.
• The elimination of manifestations of heartburn in an infant is facilitated by the intake of alginates.
• A decrease in the production of stomach acid is caused by proton pump inhibitors (omeprazole).
• Histamine H-2 blockers (Pepsid, Zantak).

If such treatment has not brought noticeable improvements and the condition is aggravated by the presence of diverticula or hernias of the esophagus, there will be a need for surgical intervention. This operation is called a fundoplication and consists in the formation of a new gastroesophageal sphincter. The esophagus is lengthened and connected to the entrance to the stomach by a special muscular ring. The procedure allows you to nullify attacks of pathological reflux.

The following diagnostic methods will help determine the feasibility of a surgical operation:

• A barium x-ray allows you to analyze the work of the upper part of the digestive system.
• 24-hour pH monitoring involves placing a thin tube into the esophagus to test for acidity and the severity of regurgitation.
• Endoscopy of the esophagus and stomach allows you to determine the presence of ulcers, erosion, swelling of the mucous membrane of organs.

• Sphincteromanometry provides data on the functioning of the organ that connects the esophagus to the stomach. The degree of sphincter closure after a meal is studied, which is directly related to episodes of reflux.
• An isotope study allows you to determine the movement of food through the upper part of the digestive system in a child.

If complicated gastroesophageal reflux begins to progress, there is a risk of complications in the form of gastroesophageal reflux disease. There are also more serious, and even life-threatening consequences of this disease, such as:

• inability to eat due to pain and discomfort, which will lead to weight loss and beriberi;
• erosive damage to the esophagus, its pathological narrowing, esophagitis (inflammation);
• food entering the respiratory tract, which can cause suffocation;
• bleeding and perforation of the organ;
• degeneration of the cells of the esophageal mucosa, which creates prerequisites for oncological diseases.

In most cases, gastroesophageal reflux in a child under one year old does not cause concern to doctors, and there is no need to treat it, since it disappears without a trace with age. If the condition continues to recur in children older than one and a half years, even with a decrease in the number of episodes, it is advisable to consult a doctor with a subsequent examination.

Pathology of the esophagus in recent years has attracted increased attention of pediatric gastroenterologists and surgeons. This is due to the fact that the reverse reflux (reflux) of the acidic contents of the stomach into the esophagus causes serious changes in the mucosa and leads to inflammatory processes of varying severity (esophagitis). This complicates the course of many diseases, if any. Reflux esophagitis in children significantly impairs the quality of life and causes many problems for parents. Today it is one of the most popular and common diseases of the esophagus.

Anatomy, its role in the development of reflux

The pressure in the abdominal cavity is much higher than in the chest. Normally, the contents of the stomach cannot enter the esophagus, because the muscular sphincter (pulp, muscle ring) in the lower part of the esophagus, being in a closed state, prevents this. Only a food bolus or liquid can pass when swallowed. The intake of food in the opposite direction normally does not occur due to the tightly compressed esophageal sphincter. Sometimes a healthy child has a short-term reflux: this happens 1-2 times a day, lasts a short time and is considered the norm.

Disease in newborns

Reflux esophagitis in a child occurs due to the anatomical structure of the digestive organs in children.

In infants, the cardial section of the stomach is underdeveloped due to the imperfection of the neuromuscular apparatus, which leads to functional inferiority. This is manifested by frequent regurgitation of air and stomach contents after feeding. Reflux at this age is considered normal, provided that the child develops normally and gains weight. The formation of sphincters begins at four months. By ten months, reflux stops. In the second year of life, the child should not have reflux. Their appearance indicates the pathology of one of the departments of the digestive system.

There is an opinion that reflux in newborns is genetically transmitted: in some families, belching is a common occurrence, in many it is absent or very rare.

Reasons for the development of reflux

In children after a year, reflux develops due to insufficiency of the cardia of the esophagus, when the sphincter of the esophagus gapes partially or completely. This occurs with gastroduodenitis, peptic ulcer disease: due to spasms and hypertonicity of the stomach, intragastric pressure increases and the overall mobility of the digestive tract decreases.

The cause of impaired motor skills can be:

• violation of anatomy (hernia of the esophageal opening of the diaphragm, short esophagus, etc.);
• violation of the regulation of the esophagus by the autonomic nervous system (stress, motion sickness in transport);
• obesity;
• diabetes mellitus, when dry mouth and little saliva are concerned: saliva, which has an alkaline reaction, partially “extinguishes” the acidity of the stomach contents that have entered the esophagus and prevents the development of reflux esophagitis;
• diseases of the digestive system (gastritis, peptic ulcer).

Factors leading to the development of the disease

The development of reflux esophagitis is facilitated by:

• Many foods (chocolate, citrus fruits, tomatoes) that relax the muscles of the esophagogastric junction and cause frequent reflux.
• Drugs that have a relaxing effect on the muscles of the esophagus (nitrates, calcium antagonists, aminophylline, some sleeping pills, sedatives, laxatives, hormones, prostaglandins, etc.).
• Violation of the diet - overeating or a rare meal in large quantities at the same time, plentiful food before bedtime.

Clinical stages of inflammation of the esophagus

Reflux esophagitis is a pathology that is difficult to recognize in children. The inability to tell complaints, the presence of symptoms that are characteristic not only for reflux esophagitis, but also associated with other organs and systems, the impossibility of a full examination greatly complicates the diagnosis.

The disease proceeds in four stages.

• At the first stage, when the inflammatory process in the mucosa is superficial, there are practically no symptoms.
• The second stage may be accompanied by the formation of erosions in the mucosa of the esophagus, and then clinically this is manifested by burning behind the sternum, heaviness and pain in the epigastrium after eating, heartburn. Other dyspeptic symptoms that appear with reflux at this stage are belching, hiccups, nausea, vomiting, and difficulty swallowing.
• In the third stage, ulcerative lesions of the mucosa occur. This is accompanied by severe symptoms: the child has difficulty swallowing, there is severe pain and burning behind the sternum, the child refuses to eat.
• At the fourth stage, the mucosa is damaged along the entire length of the esophagus, confluent ulcers can form, covering more than 75% of the area, the child's condition is severe, all symptoms are pronounced and constantly disturb, regardless of feeding. This is the most dangerous stage, as it can be complicated by stenosis of the esophagus, the development of cancer.

The disease is detected from the second stage, when characteristic symptoms appear. In the third and fourth stages, surgical treatment is required.

Typical symptoms of reflux esophagitis

Since the onset of reflux and the subsequent development of esophagitis, the child has a variety of symptoms, which are important to notice in time to prevent further severe complications. The most frequent of them:

• Heartburn is a characteristic manifestation of reflux. It occurs regardless of food intake and with any physical activity.
• Pain, burning in the upper abdomen during or after eating leads to the fact that the child stops eating, becomes restless, whiny. These pains are aggravated by sitting or lying down, with various movements or small physical exertion.
• Over time, bad breath develops even if you have healthy teeth. Subsequently, the child's milk teeth are destroyed early.
• Growth retardation with frequent regurgitation.

Other manifestations of the disease

Reflux esophagitis, in addition to the characteristic symptoms, is manifested by extraesophageal manifestations. These include: nocturnal cough, reflux otitis, laryngitis, pharyngitis.

According to statistics, 70% of children with this pathology have manifestations of bronchial asthma, which develop due to microaspiration of the contents of the stomach. Late evening heavy feeding can provoke reflux and the development of an asthma attack in a child.

In this regard, it requires close attention:

• appeared cough, inflammation of the ear, not associated with infection;
• a change in the timbre of the child's voice;
• the destruction of milk teeth before the timing of their change;
• swallowing disorder;
• sudden weight loss;
• long-lasting hiccups;
• black feces and vomit or traces of blood in them;
• change in the child's behavior: aggression or lack of interest in toys;
• bowel problems: constipation, diarrhea, flatulence.

Treatment of the disease

Since reflux is considered normal in infants up to a certain age and resolves on its own by 10 months, when the development of the digestive tract is completed, treatment in this age period is not required. Only in the case of a lag in physical development, weight loss or in the absence of weight gain, alarming symptoms and behavioral changes should treatment be initiated.

Compliance with the regime

In both infants and older children, treatment should begin with a dietary regimen. Its rules include:

• eating in small portions;
• the vertical position of the child for some time after feeding to exclude reflux;
• refusal of any physical activity and stress after eating;
• early dinner - a few hours before bedtime;
• refusal of squeezing tight clothing, belts.

Older children are advised to use chewing gum for heartburn: their use causes the formation of a large amount of saliva, which has an alkaline reaction and helps to “quench” the acid when gastric contents reflux into the stomach. But with prolonged chewing of gum on an empty stomach for 15-20 minutes, active production of gastric juice occurs, which leads to negative consequences.

Medical treatment

Drug therapy is prescribed by narrow specialists in the initial stages (first and second) with mild symptoms that can still be corrected by taking medications. Appointments are made after research and taking into account the characteristics of the patient. The following groups of drugs are used:

• PPI proton pump inhibitors (omeprazole, pantaprazole) - they block the formation of hydrochloric acid. Omeprazole is the "gold standard" in the treatment of reflux in children from the age of two.
• H2 blockers - histamine receptors (Ranitidine, Famotidine) - reduce the acidity of gastric juice, their mechanism of action differs from PPIs, they are not used in children under one year old.
• Antacids: the purpose of their use is the neutralization of hydrochloric acid, the restoration of damaged mucosa (Phosphalugel, Maalox, Gaviscon).
• Prokinetics (Domperidone, Coordinax, Motilium, Cisapride) - increase the contraction of the muscles of the stomach, increase the tone of the esophageal sphincter, contributing to the fastest emptying of the stomach, reducing reflux.
• Enzyme preparations contribute to better digestion of food.
• Preparations for combating flatulence (Melikon).

Taking these drugs refers to symptomatic therapy, they do not eliminate the cause of the disease.

With frequent and profuse regurgitation, the child experiences dehydration and a violation of the water and electrolyte balance. In such cases, treatment is carried out in stationary conditions using infusion solutions.

Without exception, all drugs have side effects and contraindications. Therefore, the treatment of a child should be carried out only by a specialist and be fully justified.

Surgery

The third and fourth stages of reflux esophagitis require surgical intervention. Indications for surgical treatment are:

• the ineffectiveness of long-term drug treatment (if the treatment lasts several months or years to no avail);
• severe pain syndrome, not relieved by drugs;
• deep damage to the mucosa (multiple erosions, ulcers), occupying a large extent of the organ;
• aspiration syndrome;
• severe airway obstruction as a complication of esophagitis.

Compliance with the feeding regimen of the child is the main rule for the prevention of reflux esophagitis. With proper nutrition and timely access to a pediatrician, if there is the slightest suspicion of a digestive tract disease in a child, the development of reflux esophagitis and its severe complications can be avoided.