🧒🟡 Fundoplication Surgery for Reflux in Children: A Parent-Friendly Guide

✅ Fundoplication is a surgery that helps prevent severe gastroesophageal reflux (stomach contents coming back up into the esophagus).
It is usually considered when reflux causes serious complications or when symptoms do not improve with optimized medical and feeding strategies.
Many children improve significantly, but it’s important to understand what the surgery can—and cannot—do.

1) 🧾 Quick “At-a-glance” box (top of page)

✅ Procedure name: Fundoplication
Common names: Anti-reflux surgery, Nissen fundoplication (one common type)

Plain-language summary (2–3 lines):
Fundoplication wraps the top of the stomach around the lower esophagus to strengthen the “valve” and reduce reflux. It can reduce vomiting and aspiration risk in selected children. Some children still need reflux medicines after surgery.

Who it affects (typical ages):
Can be done in infants, children, and teens—most commonly in children with severe reflux, aspiration risk, or complex medical conditions.

✅ What parents should do today:

• Ask why fundoplication is being recommended (what problem it aims to solve)
• Confirm reflux has been fully evaluated and optimized medically
• Understand expected benefits and realistic limitations
• Prepare for post-op feeding and recovery plan

⚠️ Red flags that need urgent/ER care after surgery:

• Severe belly swelling with repeated retching or inability to vomit
• Fever with worsening belly pain
• Trouble breathing
• Vomiting blood or black stools

🟡 When to see the family doctor/clinic:

• Poor feeding, dehydration
• Persistent pain
• Worsening reflux symptoms or choking episodes
• Incision redness, swelling, drainage

2) 🧠 What it is (plain language)

Reflux happens when stomach contents move backward into the esophagus.

Fundoplication works by:

• tightening the junction between the esophagus and stomach
• reducing the amount of reflux
• helping protect the airway in children with aspiration risk (in selected cases)

What part of the body is involved? (small diagram required)

Common myths vs facts

• Myth: “Fundoplication fixes all reflux forever.”
  Fact: It often helps, but reflux or symptoms can persist or return in some children.
• Myth: “After surgery, my child can never vomit.”
  Fact: Some children have difficulty vomiting; this can be an important side effect.
• Myth: “Surgery is the first step for reflux.”
  Fact: Surgery is usually considered after careful evaluation and optimized non-surgical treatments.

3) 🧩 Why it happens (why fundoplication is recommended)

Fundoplication may be considered when reflux:

• causes recurrent aspiration or lung complications
• leads to poor growth despite optimized feeding
• causes severe esophagitis or strictures
• does not respond to medical therapy and feeding strategies
• is part of a plan with gastrostomy tube feeding (sometimes)

Risk factors for needing surgery

• neurologic impairment with swallowing issues
• severe GERD with aspiration
• congenital anomalies (selected cases)
• dependence on tube feeding with reflux-related complications

4) 👀 What parents might notice (symptoms & signs)

Symptoms of severe reflux

• frequent vomiting
• choking, coughing during feeds
• recurrent pneumonias
• poor weight gain
• irritability and feeding aversion

Symptoms of complications

• blood in vomit (esophagitis)
• refusal to eat due to pain
• chronic wheeze or cough

Symptom tracker (helpful)

• vomiting frequency and volume
• choking/coughing episodes
• breathing symptoms
• weight changes

5) 🏠 Home care and what helps (step-by-step)

✅ Before surgery, many children improve with feeding strategies and medical optimization. After surgery, recovery routines matter.

Before surgery: what helps

✅ Do this now:

• confirm feeding plan with your team:
  • thickened feeds (if appropriate)
  • positioning strategies
  • smaller, more frequent feeds
• ensure medicines are optimized if used
• clarify aspiration risks and respiratory plan

After surgery: first 24–48 hours

✅ Do this now:

• follow surgeon’s feeding progression plan (clear liquids → full liquids → soft feeds)
• manage pain with prescribed medicine
• encourage gentle movement as advised
• watch hydration and urine output

6) ⛔ What NOT to do (common mistakes)

• Don’t advance feeds faster than recommended.
• Don’t ignore repeated retching with belly swelling.
• Don’t stop follow-ups early even if symptoms improve.
• Don’t assume all vomiting after surgery is normal—pattern matters.

7) 🚦 When to worry: triage guidance

🔴 Call 911 / Emergency now

• trouble breathing
• severe weakness or collapse
• vomiting blood with shock signs

🟠 Same-day urgent visit

• severe belly swelling with retching and inability to vomit
• fever with worsening belly pain
• persistent vomiting with dehydration
• incision redness spreading or pus drainage

Example: “My child is retching repeatedly and belly is getting bigger.”

🟡 Book a routine appointment

• mild ongoing reflux symptoms
• feeding difficulties without dehydration
• questions about diet progression

🟢 Watch at home

• mild soreness and gradually improving appetite, following plan

8) 🩺 How doctors decide if fundoplication is needed (what to expect)

What the clinician will ask

• reflux severity and response to treatments
• aspiration symptoms and lung history
• feeding pattern and growth
• neurologic or airway conditions

Possible tests (and why)

• upper GI study (to evaluate anatomy)
• pH impedance or pH probe study (reflux burden)
• endoscopy (look for esophagitis)
• swallow study (aspiration risk)
• gastric emptying evaluation (selected cases)

What tests are usually not needed

• multiple repeated tests if decision is already clear and plan is set (team-guided)

9) 🧰 Treatment options

✅ Fundoplication is one option among several. The right choice depends on why reflux is dangerous for your child.

First-line treatment (usually before surgery)

• feeding strategy optimization
• reflux medicines when appropriate
• managing constipation and overfeeding
• allergy evaluation (selected cases)

If not improving

• reassessment for aspiration or anatomic issues
• consider feeding tube strategies
• consider surgery in carefully selected children

Surgical options

• fundoplication (types vary)
• fundoplication + gastrostomy tube (if needed)

After surgery: common effects

• less vomiting and reflux in many children
• possible gas bloat (difficulty burping)
• possible retching
• possible dysphagia (temporary swallowing difficulty)

10) ⏳ Expected course & prognosis

Typical recovery timeline

• hospital stay: varies (often a few days depending on complexity)
• feeding progression: days to weeks
• return to daycare/school: often 1–2 weeks, depending on child and surgeon advice

What “getting better” looks like

• improved comfort during feeds
• fewer choking episodes
• improved growth over time

What “getting worse” looks like

• persistent severe retching
• ongoing aspiration symptoms
• poor intake and dehydration
• recurrent severe reflux symptoms

11) ⚠️ Complications (brief but clear)

Common complications (often manageable)

• gas bloat
• difficulty burping
• temporary swallowing difficulty
• retching

Serious complications (uncommon)

• wrap slippage or failure
• obstruction
• bleeding or infection
• aspiration not improved (if the main issue is swallowing, not reflux)

12) 🛡️ Prevention and reducing future problems

• follow feeding progression instructions
• treat constipation aggressively (if advised)
• keep follow-ups with GI and surgery teams
• address swallowing/aspiration issues separately if present

13) 🌟 Special situations

Infants

Feeding progression and hydration monitoring are crucial.

Kids with neurologic impairment

Fundoplication may help reflux but does not fix swallowing dysfunction; aspiration plan still needed.

Kids with feeding tubes

Post-op tube feeding instructions should be clear; venting may be recommended.

Neurodevelopmental differences/autism

Prepare with social stories, predictable routines, and caregiver-led feeding plan.

Travel considerations

Avoid travel immediately after surgery; carry a medical summary.

School/daycare notes

Temporary restrictions on physical activity; need hydration and feed schedule accommodations.

14) 📅 Follow-up plan

• surgeon follow-up for wound and recovery
• GI follow-up for reflux and feeding
• nutrition/dietitian follow-up if growth concerns
• urgent plan for retching + belly swelling

15) ❓ Parent FAQs

“Is it contagious?”

No.

“Can my child eat ___?”

Diet progression is stepwise after surgery; long-term diet is usually normal if tolerated.

“Can they bathe/swim/exercise?”

Bathing depends on incision instructions. Swimming usually waits until healing is complete.

“Will they outgrow it?”

Some children no longer need reflux medicine; others may still need support.

“When can we stop treatment?”

Follow your team; some meds may be reduced after surgery if symptoms improve.

16) 🧾 Printable tools (high-value add-ons)

🧾 Printable: Fundoplication One-Page Action Plan

At home after surgery:

• Follow feeding progression plan
• Keep hydration and urine output tracked
• Give pain meds as prescribed
• Watch for retching + belly swelling

Call clinic if:

• poor intake or repeated vomiting
• incision redness/drainage
• reflux symptoms persist or worsen

Urgent/ER if:

• severe belly swelling with retching
• trouble breathing
• vomiting blood or black stools

🧾 Printable: Feeding Progress Tracker

Day: ______

• Allowed feeds: __________________
• Amount tolerated: ______________
• Vomiting/retching: yes/no
• Hydration: good/ok/poor

🧾 Printable: “Red Flags” Fridge Sheet

⚠️ Urgent: severe belly swelling + retching, breathing trouble, vomiting blood, black stools.

17) 📚 Credible sources + last updated date

Trusted references:

• Children’s hospital anti-reflux surgery family guides
• Pediatric GI and pediatric surgery patient education resources

Last reviewed/updated on: 2025-12-30
Local surgical approaches and feeding protocols may differ.

🧡 Safety disclaimer

This guide supports—not replaces—medical care. If you are worried about your child, trust your instincts and seek urgent medical assessment.

This guide was fully developed & reviewed by Dr. Mohammad Hussein, MD, FRCPC ROYAL COLLEGE–CERTIFIED PEDIATRICIAN & PEDIATRIC GASTROENTEROLOGIST Board-certified pediatrician and pediatric gastroenterologist (Royal College of Physicians and Surgeons of Canada) with expertise in inflammatory bowel disease, eosinophilic gastrointestinal disorders, motility and functional testing, and complex nutrition across diverse international practice settings.

To book an online assessment Email Dr. Hussein’s Assistant Elizabeth Gray at: Elizabeth.Gray@pedsgimind.ca
In the email subject, please write: New Assessment Appointment with Dr. Hussein

Important: This appointment is completely online as Dr. Hussein is currently working overseas. This service is not covered by OHIP