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Heartburn in Children and Infants

Heartburn is a common complaint in adults, especially after eating a hearty or spicy meal. Yet, infants and children also can experience that burning sensation in the chest. According to some estimates, about 2% of children ages 3 to 9, and 5% of children ages 10 to 17, have heartburn. Symptoms can even start in infancy. 

What Causes Heartburn in Infants and Children?

Heartburn in infants and young children is usually a sign of gastroesophageal reflux (also called GERD or acid reflux). That's a condition that occurs when stomach acid backs up into the esophagus -- the tube that connects the mouth to the stomach. There is a muscle at the bottom of the esophagus called the lower esophageal sphincter (LES) that normally keeps acids in the stomach. But if the LES relaxes too much, the harsh stomach acids can rise up and irritate the delicate lining of the esophagus. That leads to heartburn and other symptoms.

GERD is an uncomfortable -- but very common -- condition in infants. Up to half of all babies less than 3 months old have symptoms of the condition. Spitting up is a common sign of GERD, but many babies also experience the discomfort of heartburn. This can be seen with fussiness during feeding.

In very young children, the cause of heartburn is usually an immature digestive tract. In older children, risks include being overweight, exposure to secondhand smoke, and eating certain types of foods (for example, spicy foods). Children with neurological conditions, such as cerebral palsy, are also at greater risk.

What Are the Symptoms of Heartburn in Infants and Children?

Heartburn feels like a burning sensation in the chest, neck, and throat.

If the cause of heartburn is GERD, the infant or child may also experience other symptoms, such as:

  • Arching of the back during feedings
  • Chest pain
  • Coughing
  • Fussiness
  • Hoarse voice
  • Painful swallowing
  • Poor eating
  • Sore throat
  • Vomiting
  • Wheezing 

In addition to feeling discomfort, infants with heartburn may fail to gain weight properly. Sores can form in the esophagus from the constant backing up of acid. If not treated, GERD can lead to narrowing of the esophagus or abnormal cells in the lining of the esophagus (a condition called Barrett's esophagus). Bleeding in the esophagus and breathing problems are other complications.

How Is Heartburn Diagnosed in Infants and Children?

It's often hard to clearly diagnose heartburn in young children. That's because they have more difficulty articulating their symptoms than adults. Instead of feeling a burning in their chest, they may experience heartburn as a stomachache higher in their belly.

If your child is displaying any symptoms of heartburn or GERD, start with a visit to the pediatrician. You may get a referral to a specialist called a gastroenterologist. A gastroenterologist treats diseases of the digestive system.

The doctor will examine your child and ask about symptoms. Tests for heartburn caused by GERD include:

  • Upper GI (gastrointestinal) series. After your child drinks a chalky liquid containing a contrast material (barium), X-rays will be taken of the esophagus, stomach, and part of the intestines.
  • Endoscopy. While the child is under sedation, a small, flexible tube with a camera on the end (endoscope) is inserted through the mouth into the esophagus and stomach. It can allow the doctor to view these areas and remove a sample of tissue (biopsy) if necessary.
  • Esophageal pH probe. The doctor inserts a thin flexible tube through the child's nose and into the esophagus to test acid levels in the esophagus.
  • Gastric emptying study. After your child drinks milk that contains a special radioactive material, the doctor uses a camera to watch the substance move through the digestive tract.
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