Acid Reflux Symptoms

Acid Reflux Basics

Acid reflux or gastroesophageal reflux is actually a lot more difficult to diagnose in children than most parents believe.

Baby girl drinking milk from bottle
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Happy Spitters

Many children spit up when they are newborns and infants, but most don't necessarily have gastroesophageal reflux disease (GERD). These "happy spitters" are just a little messy and don't have any other acid reflux symptoms, such as not gaining weight well, weight loss, difficulty eating, or choking, etc.

Since they don't have other symptoms of acid reflux and aren't bothered by their spitting up, they don't need any special treatment. They should outgrow spitting up by the time they are about 12 to 18 months old.

Silent Reflux

While many infants with reflux are very messy, others don't noticeably spit up at all and can still have reflux. They might have more subtle symptoms of gastroesophageal reflux disease or GERD, such as being very fussy and not feeding well.

Since you don't see the reflux, it makes it harder to diagnose. Still, unexplained crying alone is usually not thought to be caused by reflux.

Acid Reflux Symptoms

Other acid reflux symptoms might include:

  • Irritability
  • Trouble sleeping
  • Anorexia
  • Weight loss
  • Failure to thrive
  • Arching the back while feeding
  • Apnea
  • Refusing to eat
  • Painful or difficulty swallowing
  • Recurrent abdominal pain
  • Bad breath
  • Throat clearing
  • Chest pain
  • A chronic cough, recurrent pneumonia, or persistent asthma symptoms
  • A hoarse voice
  • Sandifer syndrome - posturing episodes that are often mistaken for seizures

If your child's acid reflux symptoms are more subtle, for example, he is only fussy and never spits up, the possibility of acid reflux may be overlooked, and you may even need an evaluation by a pediatric gastroenterologist for a diagnosis.

What To Know About Acid Reflux Symptoms

Among the most important things to understand about acid reflux symptoms are that not all children with acid reflux spit up or vomit and not all young children who spit up have acid reflux.

Other things to know about acid reflux symptoms include that:

  • For infants, initial treatment for GERD usually includes lifestyle changes and for formula-fed infants, thickened feedings and a switch to an extensively hydrolyzed protein baby formula, such as Nutramigen or Alimentum
  • For older children and teens, treatment usually includes lifestyle changes (losing weight if obese, avoiding soda, spicy foods, and fried foods, etc.) and a 4 week trial of a proton pump inhibitor (PPI) to suppress acid formation
  • Obesity is a risk factor for reflux
  • Eosinophilic esophagitis can cause symptoms that are similar to acid reflux

Talk to your pediatrician if your child spits up more than you think is normal or if he has any signs or symptoms of acid reflux.

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By Vincent Iannelli, MD
 Vincent Iannelli, MD, is a board-certified pediatrician and fellow of the American Academy of Pediatrics. Dr. Iannelli has cared for children for more than 20 years.