🧒🟡 Gastroesophageal Reflux Disease (GERD) in Children: A Parent-Friendly Guide

✅ Reflux is when stomach contents come back up into the esophagus.
Many babies have mild reflux that improves with time. GERD is when reflux causes troublesome symptoms or complications (pain, poor growth, breathing issues, or esophagitis).
The goal is to keep your child comfortable, growing well, and safe—using the least intensive plan that works.

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

✅ Condition name: Gastroesophageal Reflux Disease
Common names: GERD, acid reflux, reflux disease

Plain-language summary (2–3 lines):
GERD happens when reflux irritates the esophagus or causes symptoms like pain, feeding refusal, poor weight gain, or breathing problems. Many children improve with feeding and lifestyle strategies. Some need medicine; a small number need specialist testing or surgery.

Who it affects (typical ages):

• Infants: reflux is common; GERD is less common
• Toddlers/children/teens: GERD can look like heartburn, belly pain, chronic cough, or throat symptoms

✅ What parents should do today:

• Identify pattern: spit-up vs painful reflux vs feeding refusal
• Track growth and hydration
• Try simple feeding/lifestyle steps first
• See your clinician if symptoms affect growth, sleep, feeding, or breathing

⚠️ Red flags that need urgent/ER care:

• Green (bilious) vomiting
• Vomiting blood or black stools
• Signs of dehydration (very sleepy, dry mouth, no urine)
• Breathing difficulty or choking episodes
• Poor weight gain with lethargy

🟡 When to see the family doctor/clinic:

• Feeding refusal or painful feeds
• Poor growth
• Persistent cough/wheeze or recurrent pneumonia
• Frequent vomiting beyond expected age
• Heartburn or chest pain in older child

2) 🧠 What it is (plain language)

There is a “valve” at the bottom of the esophagus (lower esophageal sphincter). It should keep stomach contents down.

Reflux happens when:

• the valve relaxes too often
• stomach pressure is high
• the stomach empties slowly
• certain foods/behaviors worsen reflux

GERD means reflux is causing problems, such as:

• pain or irritability
• feeding refusal
• poor growth
• esophagitis (inflamed esophagus)
• breathing symptoms (in some children)

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

Common myths vs facts

• Myth: “All spit-up is GERD.”
  Fact: Many babies spit up and are otherwise happy growers—this is often normal reflux.
• Myth: “Acid medicine is always needed.”
  Fact: Many children improve with feeding/lifestyle steps; medicine is for selected cases.
• Myth: “GERD always causes vomiting.”
  Fact: Older children often have heartburn, cough, or pain without vomiting.

3) 🧩 Why it happens (causes & triggers)

Common contributors

• immature reflux barrier in infants
• overfeeding or large volumes
• constipation (increases belly pressure)
• obesity in older children
• certain foods/drinks (older kids): caffeine, chocolate, peppermint, spicy/fatty foods

Less common but important causes (brief)

• food allergy (selected infants)
• eosinophilic esophagitis (EoE) causing feeding refusal/vomiting
• anatomic issues (malrotation, pyloric stenosis in young infants—pattern differs)
• delayed gastric emptying
• neurologic impairment and swallowing dysfunction (aspiration risk)

Triggers that worsen symptoms

• lying flat right after meals
• large meals, fast eating
• constipation
• exposure to smoke/vaping

4) 👀 What parents might notice (symptoms)

Infants

• frequent spit-up
• irritability during/after feeds
• back arching
• feeding refusal
• poor weight gain (GERD concern)
• coughing/choking during feeds (needs evaluation)

Toddlers/older children

• heartburn or chest burning
• sour taste, bad breath
• belly pain (upper abdomen)
• chronic cough, throat clearing
• hoarse voice
• nausea

What’s normal vs what’s not

🟢 Often normal:

• happy spitter with normal growth

⚠️ Not normal:

• feeding refusal, weight loss/poor growth
• blood in vomit, black stools
• breathing symptoms or recurrent pneumonia
• green vomiting

Symptom tracker (what to write down)

• vomiting frequency and character
• pain signs during feeds
• sleep disruption
• stool pattern (constipation?)
• growth/weights
• triggers (foods, timing, position)

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

✅ Start with low-risk steps that help many children.

What to do in the first 24–48 hours (when reflux is flaring)

✅ Do this now:

• offer smaller feeds more often (infants)
• keep baby upright after feeds (20–30 minutes)
• burp gently and frequently
• avoid overfeeding
• address constipation (ask your clinician for a plan)

Supportive care: fluids, nutrition, sleep

• maintain hydration
• keep regular meal schedule in older kids
• avoid heavy meals close to bedtime
• elevate head of bed only if advised (safe sleep rules always come first in infants)

Practical routines

• infant: paced bottle feeding if bottle-fed
• toddler/child: slow eating, avoid late-night snacks
• avoid second-hand smoke exposure

What usually makes it worse

• overfeeding
• constipation
• carbonated drinks
• caffeine (older kids)
• lying down after meals

6) ⛔ What NOT to do (common mistakes)

• Don’t put infants in unsafe sleep positions to “help reflux.”
• Don’t start acid medicines long-term without reassessment.
• Don’t ignore red flags like green vomit or blood.
• Don’t assume reflux is the only cause of feeding refusal (EoE and other issues exist).

7) 🚦 When to worry: triage guidance

🔴 Call 911 / Emergency now

• trouble breathing
• bluish color, choking episodes with poor recovery
• extreme lethargy or collapse

🟠 Same-day urgent visit

• green (bilious) vomiting
• vomiting blood or black stools
• dehydration (no urine, very sleepy)
• severe chest pain
• recurrent choking/aspiration concerns

Example: “My baby is choking with feeds and breathing fast.”

🟡 Book a routine appointment

• persistent symptoms affecting sleep/feeding
• poor growth
• chronic cough/hoarseness
• heartburn >2 times per week in older child

🟢 Watch at home

• mild spit-up with good growth and no pain, with reassurance plan in place

8) 🩺 How doctors diagnose it (what to expect)

What the clinician will ask

• feeding amounts and timing
• growth pattern
• symptom triggers
• stooling and constipation
• breathing symptoms

Physical exam basics

• growth measurements
• hydration status
• abdominal exam
• chest exam if cough/wheeze

Possible tests (and why)

• often none needed for mild reflux with good growth
• trial of lifestyle/feeding strategies
• pH probe or pH-impedance (reflux burden)
• endoscopy (esophagitis, EoE)
• swallow study if aspiration suspected
• upper GI study if anatomic concerns

What tests are usually not needed

• extensive testing for uncomplicated infant spit-up with normal growth

9) 🧰 Treatment options

✅ Treatment is stepwise.

First-line treatment

• feeding/lifestyle changes
• constipation management
• thickened feeds in selected infants (team-guided)

If not improving (next steps)

• medication trial in selected cases:
  • acid suppression (short-term, reassess)
• dietitian support if poor growth
• evaluate for EoE or other causes if feeding refusal persists

Severe cases (hospital care / procedures)

• aspiration complications or severe growth failure
• surgical options (fundoplication) in carefully selected children, usually with high-risk complications

Medication/treatment guidance (parent-friendly)

• What it does: reduces acid irritation (does not stop all reflux events)
• How to give it: timing matters; follow instructions
• Common side effects: stomach upset, headache (varies)
• Serious side effects (rare but important): infection risk changes with long-term acid suppression (discuss with clinician)
• When to stop and seek help: allergic reaction, severe diarrhea, new concerning symptoms

10) ⏳ Expected course & prognosis

Typical timeline

• infant reflux often improves by 12–18 months
• GERD in older children varies; lifestyle and medication can help significantly

What “getting better” looks like

• less discomfort
• feeds improve
• better sleep
• normal growth trend

What “getting worse” looks like

• worsening feeding refusal
• weight loss
• blood in vomit/stool
• respiratory complications

Return to school/daycare/sports

• usually no restrictions once stable

11) ⚠️ Complications (brief but clear)

Common complications

• esophagitis (inflammation)
• feeding aversion

Serious complications

• strictures (narrowing) in severe longstanding esophagitis (uncommon)
• aspiration-related lung issues in selected children

12) 🛡️ Prevention and reducing future episodes

• healthy meal patterns
• weight management in older children if needed
• avoid smoke exposure
• treat constipation early
• avoid late-night heavy meals
• consistent follow-up if chronic symptoms

13) 🌟 Special situations

Infants

Safe sleep rules always come first. Feeding adjustments should be guided.

Teens

Caffeine/energy drinks and late-night eating are common triggers.

Kids with chronic conditions (asthma, diabetes, immunosuppression)

Reflux symptoms may overlap with cough; coordinated care helps.

Neurodevelopmental differences/autism

Use predictable meal routines and sensory-friendly foods; watch for silent reflux behaviors.

Travel considerations

Bring medicines and feeding plan; avoid big meals before long car rides.

School/daycare notes

• allow water bottle
• avoid large rushed meals
• document any choking events

14) 📅 Follow-up plan

• follow-up with family doctor for growth and symptom response
• pediatric GI referral if:
  • poor growth
  • bleeding
  • persistent symptoms despite first-line plan
  • aspiration concerns

15) ❓ Parent FAQs

“Is it contagious?”

No.

“Can my child eat ___?”

Yes—avoid major restrictions unless advised. Identify triggers and focus on balance.

“Can they bathe/swim/exercise?”

Yes.

“Will they outgrow it?”

Many infants improve with time. Older children may need longer-term lifestyle support.

“When can we stop treatment?”

When symptoms are controlled and growth is stable; medicines should be reassessed and tapered with clinician guidance when appropriate.

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

🧾 Printable: GERD One-Page Action Plan

Daily:

• Smaller meals/feeds
• Upright after meals
• Treat constipation
• Track triggers

Call clinic if:

• feeding refusal
• poor growth
• chronic cough/hoarseness
• symptoms persist despite plan

Urgent/ER if:

• green vomiting
• vomiting blood / black stools
• dehydration
• breathing trouble

🧾 Printable: Symptom & Trigger Tracker

Date: ______

• Symptoms: heartburn / vomit / cough / pain
• Trigger foods/activities: ______
• Stool pattern: ______
• Sleep disruption: yes/no
• Notes: _______________________

🧾 Printable: “Red Flags” Fridge Sheet

⚠️ Urgent: green vomit, blood in vomit, black stools, dehydration, breathing trouble.

17) 📚 Credible sources + last updated date

Trusted references:

• Children’s hospital GERD family education pages
• Pediatric GI society patient education resources

Last reviewed/updated on: 2025-12-30
Local guidance may differ based on age, symptoms, and risk factors.

🧡 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