Friday, June 17, 2016

GERD in Children

GERD in Children

Studies* show that GERD is common and may be overlooked in infants and
children. It can cause repeated vomiting, coughing, and other respiratory
problems. Children's immature digestive systems are usually to blame, and
most infants grow out of GERD by the time they are 1 year old. Still, you
should talk to your child's doctor if the problem occurs regularly and
causes discomfort. Your doctor may recommend simple strategies for avoiding
reflux, like burping the infant several times during feeding or keeping the
infant in an upright position for 30 minutes after feeding. If your child is
older, the doctor may recommend avoiding

   - sodas that contain caffeine
   - chocolate and peppermint
   - spicy foods like pizza
   - acidic foods like oranges and tomatoes
   - fried and fatty foods

Avoiding food 2 to 3 hours before bed may also help. The doctor may
recommend that the child sleep with head raised. If these changes do not
work, the doctor may prescribe medicine for your child. In rare cases, a
child may need surgery.

How is GERD treated?

If you have had heartburn or any of the other symptoms for a while, you
should see your doctor. You may want to visit an internist, a doctor who
specializes in internal medicine, or a gastroenterologist, a doctor who
treats diseases of the stomach and intestines. Depending on how severe your
GERD is, treatment may involve one or more of the following lifestyle
changes and medications or surgery.
Lifestyle Changes

   - If you smoke, stop.

   - Do not drink alcohol.

   - Lose weight if needed.

   - Eat small meals.

   - Wear loose-fitting clothes.

   - Avoid lying down for 3 hours after a meal.

   - Raise the head of your bed 6 to 8 inches by putting blocks of wood
   under the bedposts-just using extra pillows will not help.


Your doctor may recommend over-the-counter antacids, which you can buy
without a prescription, or medications that stop acid production or help the
muscles that empty your stomach.

*Antacids*, such as Alka-Seltzer, Maalox, Mylanta, Pepto-Bismol, Rolaids,
and Riopan, are usually the first drugs recommended to relieve heartburn and
other mild GERD symptoms. Many brands on the market use different
combinations of three basic salts-magnesium, calcium, and aluminum-with
hydroxide or bicarbonate ions to neutralize the acid in your stomach.
Antacids, however, have side effects. Magnesium salt can lead to diarrhea,
and aluminum salts can cause constipation. Aluminum and magnesium salts are
often combined in a single product to balance these effects.

Calcium carbonate antacids, such as Tums, Titralac, and Alka-2, can also be
a supplemental source of calcium. They can cause constipation as well.

*Foaming agents*, such as Gaviscon, work by covering your stomach contents
with foam to prevent reflux. These drugs may help those who have no damage
to the esophagus.

*H2 blockers*, such as cimetidine (Tagamet HB), famotidine (Pepcid AC),
nizatidine (Axid AR), and ranitidine (Zantac 75), impede acid production.
They are available in prescription strength and over the counter. These
drugs provide short-term relief, but over-the-counter H2 blockers should not
be used for more than a few weeks at a time. They are effective for about
half of those who have GERD symptoms. Many people benefit from taking
H2blockers at bedtime in combination with a proton pump inhibitor.

*Proton pump inhibitors* include omeprazole (Prilosec), lansoprazole
(Prevacid), pantoprazole (Protonix), rabeprazole (Aciphex), and esomeprazole
(Nexium), which are all available by prescription. Proton pump inhibitors
are more effective than H2 blockers and can relieve symptoms in almost
everyone who has GERD.

Another group of drugs, *prokinetics*, helps strengthen the sphincter and
makes the stomach empty faster. This group includes bethanechol (Urecholine)
and metoclopramide (Reglan). Metoclopramide also improves muscle action in
the digestive tract, but these drugs have frequent side effects that limit
their usefulness.

Because drugs work in different ways, combinations of drugs may help control
symptoms. People who get heartburn after eating may take both antacids and H
2 blockers. The antacids work first to neutralize the acid in the stomach,
while the H2 blockers act on acid production. By the time the antacid stops
working, the H2 blocker will have stopped acid production. Your doctor is
the best source of information on how to use medications for GERD.


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