Heartburn and reflux

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What are heartburn and reflux?

The muscle at the bottom of our esophagus — known as the lower esophageal sphincter — normally relaxes to let food and drink down into our stomach and then closes. When that muscle relaxes too much, stomach acid, food or drinks can back up into the esophagus, a process called reflux.

Reflux sometimes causes heartburn, which is a burning sensation felt behind the breastbone when stomach acid moves into the esophagus. Chronic heartburn and reflux can be a sign of gastroesophageal reflux disease or another GI condition, but everyone experiences these symptoms from time to time. Occasional heartburn and reflux are not harmful, and the best treatment is usually to avoid things that trigger symptoms.

What causes heartburn and reflux?

Reflux is very common in babies because the esophageal sphincter is still weak, which is why babies frequently spit up. Some foods (especially spicy and greasy foods), caffeine, and smoking or exposure to second-hand smoke can trigger reflux. Some medications, including ibuprofen, can lead to reflux by irritating the stomach’s lining. Even severe constipation can cause reflux symptoms if a child has considerable stool backup that is delaying gastric emptying.

How common are heartburn and reflux?

These symptoms are very common. We often experience reflux when we burp or have the hiccups, but not everybody experiences discomfort or pain with reflux.

What are the symptoms of heartburn and reflux?

Babies with reflux may be especially irritable and cry a lot during and after mealtimes. Older children may complain of:

  • Burning sensation in the chest
  • Belching
  • Sour taste in the mouth
  • Vomiting

Who is at risk of developing this condition?

Everyone experiences heartburn and reflux at least occasionally. GERD and some conditions that can cause heartburn and reflux — including food allergies or H. pylori infections — are more likely to run in families. Children with asthma and those who are overweight are also more likely to develop reflux symptoms.

Why are heartburn and reflux a concern?

If reflux is a chronic problem, it can damage the esophageal lining and lead to ulcers. Children with frequent heartburn and reflux should also be evaluated because some related conditions, such as eosinophilic esophagitis and esophageal achalasia, get progressively worse if untreated. Infants should be evaluated if they are losing weight or if they have not outgrown the problem by age 1.

How are heartburn and reflux diagnosed/evaluated?


The doctor or nurse practitioner will first get a detailed medical history, which could reveal an obvious trigger for your child’s heartburn and reflux, such as a medication that’s known to irritate the stomach lining. For children who are 2 and older, the doctor might recommend an upper GI series, endoscopy, 24-hour pH-impedance probe, esophageal manometry or gastric emptying study to evaluate for GERD or another underlying GI condition. Because reflux is so common in infants, testing isn’t usually done unless their symptoms are unusually severe or they have not outgrown the problem by their first birthday.


What is the treatment for heartburn and reflux?

Diet and lifestyle changes can be very effective in treating heartburn and reflux with older children. Your child should try not to overeat; smaller, more frequent meals are less likely to cause heartburn and reflux. Your child should try to avoid things that can aggravate reflux, including:

  • Greasy, high-fat and fried foods
  • Citrus foods
  • Tomatoes and tomato products
  • Chocolate
  • Mint
  • Alcohol and cigarette smoke

Reflux also happens more when you’re lying down, so your child should try not to eat or drink two hours before bed. If your child is overweight, the doctor might recommend a weight-loss plan to help alleviate heartburn and reflux.

Treatment isn’t always necessary with infants. Babies with reflux might cry because they’re scared of spitting up or are bothered by regurgitated liquid coming out of their nose, but that doesn’t necessarily mean they need medication. Reflux medications come with side effects — including headaches, constipation and increased risk of pneumonia and intestinal infections — and it’s generally safest to wait for babies to outgrow the problem. However, some simple changes in feeding routines can reduce reflux symptoms in infants:

  • After feedings, place your infant on his or her stomach with the upper body elevated at least 30 degrees or hold your baby in a sitting position in your lap for 30 minutes.
  • If bottle-feeding, keep the nipple filled with milk so your infant does not swallow too much air while eating. Try different nipples to find one that allows your baby’s mouth to make a good seal during feeding.
  • Adding rice cereal to feeding may be beneficial for some infants.
  • Burp your baby several times during bottle-feeding or breastfeeding. Your child may reflux more often when burping with a full stomach.
  • Changing your baby’s formula or avoiding milk or soy if you’re a breastfeeding mother can help if a food sensitivity is causing the reflux.

Some infants with reflux will not be able to gain weight due to frequent vomiting. If that’s the case, your child’s doctor may recommend:

  • Adding rice cereal to baby formula
  • Increasing calories by adding a prescribed supplement to formula or breast milk
  • Nasogastric tube feedings: Formula or breast milk is given through a tube that is placed in the nose, guided through the esophagus and into the stomach. Tube feedings can be given in addition to or in place of regular feedings.

What happens after treatment?

If the symptoms persist, then your child may need to be evaluated to see if there’s another medical condition causing the heartburn and reflux.

When should you contact a physician?

Talk to your pediatrician if your child is experiencing heartburn or other reflux symptoms every day.

What is the long-term outlook for heartburn and reflux?

If your child makes the right lifestyle choices and follows his or her treatment plan, then heartburn and reflux symptoms should resolve or at least be manageable. Most babies outgrow reflux.

How do I live with heartburn and reflux?

Taking over-the-counter reflux medicine might alleviate your child’s pain, but it won’t necessarily stop reflux unless your child makes the recommended lifestyle changes. Follow your provider’s advice for the best results.

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