Reflux, acid reflux, heartburn and GERD all involve the same muscle — the lower esophageal sphincter. This muscle opens to let food into the stomach, then closes to keep it there. When it relaxes too often or too long, food or stomach acid can flow back into the esophagus. That’s reflux.

In older kids and teens, reflux may cause more discomfort, since the stomach contents contain more acid. This is acid reflux, and it can lead to heartburn — a burning pain in the chest or throat.

Occasional heartburn is common and usually not a concern if your child is growing well. They can usually avoid it with small changes like skipping trigger foods.

Some foods relax the esophageal muscle or increase stomach acid, which can lead to heartburn. These are common heartburn triggers, including: 

• Chocolate, peppermint, high-fat foods and caffeine
• Spicy or acidic foods like citrus, tomatoes and tomato sauces
• Sugary or processed foods
• Exposure to tobacco smoke or alcohol

Occasional acid reflux and heartburn can be normal for older kids. But if reflux happens often or causes pain or trouble eating, it may be more than just typical heartburn. It could be a sign of GERD or another GI disease.

GERD is frequent reflux that can cause irritation and inflammation in the lining of the stomach and esophagus. This can cause pain and affect quality of life.

Some of the most common symptoms of GERD include:

• Abdominal pain
• Frequent burping or hiccups
• Not eating or poor appetite
• Frequent stomachaches, nausea or vomiting
• Frequent coughing, gagging or choking
• Pain when swallowing
• Frequent sore throats in the morning and throat clearing
• Sour taste in the mouth
• Foul breath

Talk to your child’s doctor if you notice:

• Frequent vomiting or spit-up past 12 months of age
• Heartburn or chest pain more than twice a week
• Trouble swallowing, gagging, choking or feeling like food gets stuck
• Chronic cough, throat clearing, hoarseness or wheezing (especially at night)
• Poor weight gain or weight loss
• Fussiness or arching the back during feedings (in babies)
• Frequent pain, nausea or vomiting after meals

Some other GI issues that may cause excessive reflux or heartburn include:

• Helicobacter Pylori infection: A bacterial infection. It irritates the stomach lining and can lead to ulcers.
• Eosinophilic esophagitis: An allergic condition that causes inflammation in the esophagus.
• Food sensitivities: Foods like milk, eggs or wheat can trigger reflux-like symptoms, even without a full allergy.
• Delayed gastric emptying (gastroparesis): When food moves too slowly through the stomach.
• Functional dyspepsia: Ongoing upper belly discomfort or reflux symptoms with no clear medical cause.
• Stress: Anxiety can trigger stomach upset or heartburn symptoms in older kids and teens. This happens even when there isn’t a physical issue or trigger.

We’ll base your child’s heartburn, reflux and GERD care plan on a number of factors. We tailor a care plan to your child's:

• Age
• Health
• Medical history
• Unique diagnosis
• Tolerance for treatments

Whenever possible, we start with simple changes to diet and routine. This helps reduce symptoms while avoiding the side effects of medicine.

In many cases, GERD can improve with changes like:

• Avoiding certain medicines: Some medicines can irritate the stomach or esophagus. If your child takes any of these, we’ll talk about safer options.
• Limiting trigger foods: We’ll help you figure out what affects your child most.
• Serving smaller portions: Offer smaller meals and healthy snacks during the day.
• Keeping upright after meals: Don’t let your child lie down or go to bed right after eating. Try to serve dinner at least two hours before bedtime.
• Supporting a healthy weight: If your child is overweight, we’ll work with you to build a safe plan for gradual, healthy weight loss.

At Children’s Wisconsin, we know how stressful reflux and heartburn can be for both your child and your family. Whether it’s occasional spit-up or a more complex case of GERD, our team is here to help.

For babies under 18 months without feeding issues, we offer care through our Constipation and Reflux Program. This team focuses on noninvasive care, using diet and behavior changes. If your baby is already on reflux medicine, we can help you safely wean off when it’s no longer needed.

Our multidisciplinary feeding team sees kids with feeding challenges. Our pediatric gastroenterologists, who are experts in digestive disease, see our older kids and teens with GERD.

When reflux symptoms are severe, persistent or complex, we turn to our Neurogastroenterology, Motility and Autonomic Disorders Program. This is one of the few in the country with full pediatric motility testing.

This team helps when:

• Symptoms aren’t improving with standard care
• There are signs of delayed gastric emptying
• The esophagus isn’t moving food properly
• Reflux happens with fatigue, nausea or dizziness
• We need to take a deeper look at the gut-brain connection

We bring together motility experts, advanced testing and a whole-child approach. We help your child eat better, sleep better and feel more like themselves.

Your First Visit

At your first visit, we take time to understand your child’s full story. We’ll look at their symptoms, medical history, test results and any treatments you’ve already tried. Your child will get a physical exam and we may suggest further testing to better see how their digestive system is working.

Tests may include:

• Upper GI series: A type of X-ray that checks for blockages or other structural issues.
• Upper endoscopy: A camera test that lets us look at the inside of the esophagus, stomach and small intestine.
• 24-hour pH impedance testing: Tracks how often acid and non-acid reflux happens and how it affects your child.
• Esophageal manometry: Measures how well the muscles in the esophagus are working.
• Gastric emptying study: A scan that shows how quickly food leaves the stomach. This can be used to check for slow stomach emptying called gastroparesis.

We’ll explain every step and answer your questions. Then, we’ll work with you to build a care plan that fits your child’s needs and your family’s goals.

During Treatment

We focus on relieving symptoms and protecting your child’s esophagus. We support their diet, emotional well-being and daily routines.

Your child’s care team may include:

• A pediatric gastroenterologist
• Nurses and nurse practitioners trained in reflux and motility disorders
• Dietitians who help with feeding issues or special diets
• Psychologists who support kids with chronic illness
• Surgeons, if your child needs a procedure like fundoplication to reduce reflux
• Pain and symptom management specialists

We check in regularly and adjust the plan as your child grows. If your child is struggling with feeding, sleep, school or social life, we’ll help you find solutions that work for your family.