How reflux presents

The list below gives a general overview of some of the signs and symptoms of infant reflux that may be displayed. A child with reflux will not necessarily display all of them, and the number of signs exhibited does not indicate the severity of their ‘reflux’.

There are other signs your child may display as well. If you suspect your child may have reflux (either gastro-oesophageal reflux or gastro-oesophageal reflux disease), or have any questions or concerns, it is important to discuss them with your child’s doctor or child health nurse.

Reflux is not the only cause of these signs, and there can be other reasons for their issues or behaviour. Healthy infants can also reflux at times. Children with reflux do not necessarily vomit – this is commonly called silent reflux.

Gastro-oesophageal reflux is a normal physiological event – it is termed gastro-oesophageal reflux disease when it results in harm. However, signs and symptoms do not always correlate with the severity of reflux, and it can be difficult for a doctor to determine whether a child has gastro-oesophageal reflux (the condition) or gastro-oesophageal reflux disease. Therefore, the following list makes no distinction about whether signs may be related to GOR or GORD.

Symptoms in Infants and Children under the age of 2 years

• Irritability, excessive crying or screaming
• Vomiting, posseting or regurgitation
• Appearing to be in pain
• Recurrent hiccups
• ‘Wet’ burp or hiccups
• Congestion, ‘snuffling’ or appearing to have a cold
• Bad or sour smelling breath
• Feeding issues
  – displaying a fear of food or unwillingness to eat
  – pulling away and arching their back
  – crying during or after feeds
  – refusal to feed or only taking a small amount despite being hungry
  – comfort feeding- wanting to feed or suck frequently
• Sleeping issues
  – catnapping during the day
  – difficulty settling
  – frequent night waking (though some refluxers do sleep well at night)
  – restless or easily disturbed sleep
• Hoarseness
• Gulping, Gagging, spluttering
• Difficulty swallowing
• Respiratory problems e.g. choking, coughing, wheezing or frequent chest infections
• Weight issues e.g. inadequate weight gain, weight loss or excessive weight gain
• Frequent red, sore throat, with infection not necessarily a factor
• Recurrent ear, throat or sinus infections or croup
• Drooling or excessive salivation
• Dental erosion/decay
• Gagging themselves (using their hand/fist/fingers)

Gastro-oesophageal reflux commonly presents with regurgitating or posseting; however, there are many other signs that infants and children can display. Some babies reflux without it coming out of their mouths (termed silent reflux, although the term ‘silent reflux’ can be confusing, because silence is generally not one of the signs they exhibit)

Symptoms in Older Children

Signs and symptoms can change as children get older. While older children/teenagers may have some of the previously listed signs and symptoms, they may also suffer from issues such as –

• Nausea, vomiting or indigestion
• Heartburn, pain or discomfort in their chest or abdomen
• Feeling of a lump in their throat, frequent throat clearing
• Bitter or sour taste in their mouth
• Difficulty swallowing
• Chronic red, sore throat
• Sleeping issues e.g. insomnia, night waking
• Eating issues e.g. low appetite, fussy eating or constant grazing
• Respiratory issues e.g. wheezing, coughing, chest infections
• ENT (ear, nose and throat) issues e.g. sinus infections, hoarseness
• Behavioural issues

Information reviewed by:

References

Barmby, L. (1998 (edited 2004)). Breastfeeding the Baby with Gastroesophageal Reflux. Retrieved August 8, 2010, from La Leche League International: http://www.llli.org/NB/NBNovDec98p175.html

Boyce, H. W., & Bakheet, M. R. (2005). Sialorrhea – A Review of a Vexing, Often Unrecognised Sign of Oropharyngeal and Esophageal Disease. Journal of Clinical Gastroenterology , 39 (2), 89-97.

Campanozzi, A., Boccia, G., Pensabene, L., Panetta, F., Strisciuglio, P., Marseglia, A., et al. (2009). Prevalence and Natural History of Gastroesophageal Reflux: Pediatric Prospective Survey. Pediatrics , 123 (3), 779-783.

CDHNF. (2005). Parent’s Checklist for REFLUX in Infants 0-12 months old. Retrieved August 8, 2010, from Pediatric GERD: http://gerd.cdhnf.org/User/Docs/pdf/GERD_Checklist.pdf

CDHNF. (2007, September 24). Pediatric Gastroesophageal Reflux Evaluation and Management. Retrieved April 28, 2008, from Children’s Digestive Health and Nutrition Foundation: http://gerd.cdhnf.org/User/Docs/PDF/Slides/GERD_Core_Set_1_Hour.pdf

Cradle 2 Kindy. (2008, April 29). Irritable Baby Syndrome – colic/reflux . Retrieved August 8, 2010, from Cradle 2 Kindy Parenting Solutions: http://www.cradle2kindy.com.au/BlogRetrieve.aspx?BlogID=1159&PostID=15358

Harnsberger, J. K. (2008). Management Algorithm #2: Management of a Child or Adolescent With Chronic Heartburn. Retrieved April 2, 2008, from Medscape Pediatrics: http://cme.medscape.com/viewarticle/494079_3

NDDIC. (2006, August). Gastroesophageal Reflux in Children and Adolescents. Retrieved March 28, 2008, from National Digestive Diseases Information Clearinghouse: http://digestive.niddk.nih.gov/ddiseases/pubs/gerinchildren/index.htm

Schwarz, S. M., & Hebra, A. (2008, Jan 18). Gastroesophageal Reflux. Retrieved March 24, 2008, from eMedicine: http://www.emedicine.com/PED/topic1177.htm

Vandenplas, Y., Lifshitz, J. Z., Orenstein, S., Lifschitz, C. H., Shepherd, R. W., Casaubón, P. R., et al. (1998). Review Article. Nutritional Management of Regurgitation in Infants. Journal of the American College of Nutrition , 17 (4), 308 – 316.

Vandenplas, Y., Salvatore, S., & Hauser, B. (2005). The diagnosis and management of gastro-oesophageal reflux in infants. Early Human Development , 81 (12), 1011 – 24. Abstract available at http://www.earlyhumandevelopment.com/article/S0378-3782%2805%2900202-1/abstract

Written by Glenda Blanch (RISA Inc member) and author of “Reflux Reality: A Guide for Families” in association with RISA Inc © 2010

Additional information on gastro-oesophageal reflux is provided in our book “Reflux Reality: A Guide for Families”.

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