What is Gastroesophageal reflux disease (GERD)?

  • A condition in which stomach contents including acid back up into esophagus (or even into throat or back of nasal airway, in which case it’s often referred to as laryngopharyngeal reflux or LPR)
  • More prevalent in asthma patients and a potential asthma trigger
  • Particularly common in premature infants and observed in 20-40% of children under age 6


  • Occurs when lower esophageal sphincter (ring of muscles separating top of stomach from esophagus) doesn’t close tightly and allows stomach contents to leak back up
  • Chronic leaking irritates esophagus (tube between stomach and throat), causing burning sensation, discomfort and other symptoms

Signs and Symptoms

In Infants
  • Arching
  • Coughing
  • Poor appetite
  • Failure to thrive
  • Vomiting and regurgitation

Aggravating Factors

  • Consuming large meals
  • Wearing tight clothing
  • Eating foods that enable stomach contents to flow back into esophagus by causing pressure of sphincter between stomach and esophagus to decrease, including:
    • Fatty foods
    • Chocolate
    • Alcohol
    • Caffeine
    • Peppermint

Diagnosis and Testing

  • Upper GI series or barium swallow
  • Milk scan
  • Sleep study with pH probe: 24-hour esophageal pH monitoring very reliable for diagnosing GERD
  • Endoscopy with biopsies


  • Lifestyle changes
    • Manage weight if overweight
    • Stop smoking and avoid second-hand smoke
    • Elevate head of bed four inches with wedge
    • Adopt a high-protein, low-fat diet
    • Avoid trigger foods (acidic foods, caffeine, chocolate, spicy foods, alcohol, fatty foods)
    • Avoid large meals
    • Limit eating or drinking between meals and within two hours before bed and exercise
  • Acid suppression medications:
    • Histamine type 2 receptor antagonists (H2RA) such as Zantac (ranitidine), Pepcid (famotidine), Tagamet
    • Proton pump inhibitors that directly inhibit gastric secretion such as Prilosec, Prevacid, Nexium
    • Antacid medications such as Maalox, Mylanta, Rolaids, Tums
  • Trials of anti-reflux therapy may be used to determine if GERD is triggering asthma. Anti-reflux medicine often reduces amount of medicine needed to control asthma.

For infants and young children:

  • Reduce exposure to tobacco smoke since nicotine lowers pressure of lower esophageal sphincter.
  • Offer smaller feedings to reduce frequency or severity of reflux.
  • Consider a short milk-free trial diet for infants with problematic reflux (not “happy spitters”) since a milk intolerance can mimic GERD, especially if co-occurring with eczema, blood in stool or strong family history of allergy.
  • Keep infants upright for 10-20 minutes after feeding to reduce likelihood of regurgitation. But DON’T position child in an infant seat after meals because this can increase reflux and be extremely dangerous due to poor neck control.
  • Remember all infants less than a year old should sleep on their back for sleep since sleeping on their stomach is associated with sudden infant death syndrome (SIDS).