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 GER 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. Sometimes, it moves into or out of the mouth. That leads to heartburn and other symptoms.
GERD, a more serious form of GER, affects just over 1% of infants. The baby's spit-up is stronger, often repetitive, and babies may 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. It tends to go away by the time they are 1 year old.
In older children, the causes of GERD are different than for infants and adults. In many cases, it happens when the muscular valve between the stomach and esophagus relaxes or when pressure builds up below that valve.
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 that won't go away
- Hoarse voice
- Painful swallowing
- Poor eating
- Sore throat
- Refusing to eat or trouble eating (a child may choke or gag)
- Crying during or after feeding
Keep in mind that these symptoms are seen in other conditions, so may not necessarily be a sign of GER or GERD.
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, breathing problems, and feeding issues.
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. If your child has breathing problems, this test also can help the doctor tell if they’re the result of reflux.
- 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. It will show if their reflux happens because their stomach empties too slowly.
Heartburn Treatment for Children
Treatment will depend on your child's age and the cause of the heartburn.
Though it usually improves on its own by the time the child reaches their first birthday, heartburn in infants can be difficult to treat. One study that reviewed several common home heartburn relief methods showed that most didn't work -- including putting the infant to sleep in a more upright position (even though this is still recommended), thickening the baby formula, or using a pacifier. Burping your infant or keeping them upright for about 30 minutes after feeding may help, though.
Medications can be effective treatments for heartburn that doesn't improve on its own, but should not be considered the first course of treatment. Heartburn drugs include:
- H2 blockers (Pepcid, Tagamet)
- Proton pump inhibitors (such as Dexilant, Nexium, Prevacid, and Prilosec)
Both of these types of medications reduce the amount of stomach acids produced, so there is less acid to back up into the esophagus.
You can also try these methods to help relieve frequent heartburn in children:
- Give your child smaller meals throughout the day, rather than three large meals.
- Don't let your child eat within 2 or 3 hours of bedtime.
- Avoid giving your child caffeine and spicy, fried, or acidic foods. Foods to avoid if your child has frequent heartburn include chocolate, caffeinated soda, peppermint, oranges and other citrus fruits, and tomatoes.
- Raise the head of your child's bed 6 to 8 inches by putting blocks of wood under the bedposts (extra pillows won't help).
- Encourage them to get regular exercise.
If the symptoms continue, medicine may be needed. Medicines to help with gas include:
- Calcium carbonate antacid
The doctor might also prescribe a medicine to help your child’s stomach make less acid. But researchers aren't sure whether these drugs ease reflux in infants.
For the most part, antacids and gas-fighting drugs are safe. At high doses, antacids can cause some side effects, such as diarrhea. If your child takes high doses of them for a long time, they might have a higher risk of thinning bones, called rickets, or vitamin B12 deficiency.
Surgery for Reflux in Children
In rare cases, a child may need surgery. It can help those who’ve tried other treatment that hasn’t worked or kids who have breathing problems, pneumonia, or other serious problems from GERD.
The procedure is called fundoplication, and it involves wrapping the upper part of the stomach around the lower esophageal sphincter (the ring of muscle that opens and closes to allow food into the stomach) to create a band that prevents stomach acids from backing up. As with any operation, there are some risks. Talk about them with your child's doctor. They can help you decide if it’s the right treatment for your child.