Understanding Childhood Reflux: When to Seek Medical Attention

Understanding Childhood Reflux: When to Seek Medical Attention

Published on Tuesday, April 09, 2024 by Haley McGaha

Recognizing Red Flags and When to Seek Pediatric Guidance for Acid Reflux 

Is your child's occasional spit-up turning into constant discomfort? Since one-quarter of all routine 6-month infant visits are spent discussing reflux, we thought uncovering the warning signs suggesting childhood reflux needs medical attention would be helpful. The hope is to help you learn when to consult a pediatrician and what to expect during an evaluation. 

Understanding the Spectrum of Reflux Symptoms in Children: Know the Difference! 

According to the American Academy of Pediatrics, reflux symptoms differ depending on your child's age. In infants (babies less than one year of age), some symptoms of reflux that you may see are vomiting, feeding refusal, poor weight gain, and arching of the back during feedings. Other symptoms that are not so commonly talked about include respiratory and ear infections. Symptoms of GERD in children older than one may include vomiting, stomach pain, or refusal to eat. It’s not until a child is older that their reflux symptoms may resemble that of an adult - heartburn, chest pain, and sour burps. 

When to Call the Doctor – Don't Ignore These Warning Bells: 

For many children, a visit to the pediatrician to discuss symptoms and to have a physical exam is generally enough to diagnose reflux and start treatment or implement lifestyle strategies. However, there are a few red flags that demand immediate medical attention. Some red flags to pay attention to are bilious vomiting (vomiting yellow or greenish liquid), GI tract bleeding (throwing up blood or pooping blood), consistent, forceful vomiting, fever, lethargy, seizures, tenderness in the stomach, frequent coughing or failure to thrive (inadequate growth). 

Decoding the Doctor's Visit: What to Expect During a Pediatric Reflux Evaluation

You may hear some medical terms thrown around when seeing a pediatrician or gastroenterologist. It can be hard to navigate your options if you don’t have the full picture. So, let’s break down what to expect during a reflux evaluation. Your doctor may recommend diagnostic tests to verify that your child is struggling with reflux. A few test methods are: 

  1. Upper gastrointestinal (GI) tract contrast radiography - this looks at the upper GI tract by means of X-ray 
  2. Esophageal pH/impedance monitoring - esophageal pH monitoring measures how often stomach acid enters the esophagus 
  3. Upper endoscopy with esophageal biopsy - this procedure looks at your upper digestive system by means of a small camera on the end of a long, flexible tube, and the biopsy is typically done on any irregularities 
  4. Motility studies - this is a test to measure the movement and function of the esophagus or GI tract to ensure things are being digested appropriately and within a timely manner 

Please feel free to leave a comment and share your experience with your pediatric reflux evaluation! Since not all doctors are the same, I think hearing others' experiences can help parents be more prepared when visiting their child's pediatrician. This can help provide valuable insight for other parents navigating similar anxieties. 

  1. Esophageal 24-hour PH/impedance reflux monitoring. Esophageal 24-hour pH/Impedance Reflux Monitoring | University of Michigan Health. (n.d.-a). https://www.uofmhealth.org/conditions-treatments/digestive-and-liver-health/Esophageal-24-hour%20pH-impedance-reflux-monitoring 
  2. Harris, J., Chorath, K., Balar, E., Xu, K., Naik, A., Moreira, A., & Rajasekaran, K. (2022). Clinical Practice Guidelines on Pediatric Gastroesophageal Reflux Disease: A Systematic Quality Appraisal of International Guidelines. Pediatric gastroenterology, hepatology & nutrition, 25(2), 109–120. https://doi.org/10.5223/pghn.2022.25.2.109 
  3. Lightdale, J. R., Gremse, D. A., & Section on Gastroenterology, Hepatology, and Nutrition (2013). Gastroesophageal reflux: management guidance for the pediatrician. Pediatrics, 131(5), e1684–e1695. https://doi.org/10.1542/peds.2013-0421 
  4. Mayo Foundation for Medical Education and Research. (2022, August 26). Upper Endoscopy. Mayo Clinic. https://www.mayoclinic.org/tests-procedures/endoscopy/about/pac-20395197 
  5. Upper Gastrointestinal series. Johns Hopkins Medicine. (2019, November 19). https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/upper-gastrointestinal-series 
  6. Vandenplas, Y., Rudolph, C. D., Di Lorenzo, C., Hassall, E., Liptak, G., Mazur, L., Sondheimer, J., Staiano, A., Thomson, M., Veereman-Wauters, G., Wenzl, T. G., North American Society for Pediatric Gastroenterology Hepatology and Nutrition, & European Society for Pediatric Gastroenterology Hepatology and Nutrition (2009). Pediatric gastroesophageal reflux clinical practice guidelines: joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). Journal of pediatric gastroenterology and nutrition, 49(4), 498–547. https://doi.org/10.1097/MPG.0b013e3181b7f563 

Leave a comment on this article: