Gastroesophageal Reflux Disease in Children and Teens

Overview

Gastroesophageal reflux disease (GERD) is a condition that causes stomach contents to rise up (reflux) into the esophagus. The esophagus is the tube that carries food from the mouth to the stomach. 

GERD occurs when the muscle that connects the stomach and the esophagus (esophageal sphincter) relaxes or doesn’t close properly. Normally, this muscle opens only to let food pass from the esophagus into the stomach. If the muscle does not close properly, the contents and acids from your child’s stomach rise up into the esophagus (a symptom called acid reflux).

Your child might experience occasional acid reflux without having GERD. But if your child frequently has acid reflux, he or she might have GERD. Nearly 10 percent of teens and preteens in the United States have GERD. 

Your child may complain of a burning sensation in the chest and throat (called heartburn) and have a sour taste in the mouth. Heartburn might last as long as 2 to 3 hours and is usually worse after eating. 

Severe GERD can cause other problems, such as difficulty breathing or swallowing and irritation or bleeding in the esophagus. These problems can make eating difficult, and your child may not gain weight and grow as expected. 

With treatment, severe acid reflux and GERD can improve. For many children, simple lifestyle changes can alleviate GERD. We offer many strategies to help your child cope with symptoms. We may also recommend medications when needed. Rarely, surgery might be needed to relieve your child’s symptoms.

Causes and Risk Factors

We do not know the exact cause of GERD, but we do know that certain factors may worsen GERD symptoms. 

Obesity. Children who are overweight for their age group are more likely to develop GERD. Extra fat might put pressure on the stomach, causing the stomach contents to rise up into the esophagus. Excess body fat might also release chemicals that slow down stomach acid removal. If your child is overweight, we can talk about strategies for healthy eating and adding physical activity. 

Asthma. About 75 percent of people with asthma also have GERD. The risk of getting GERD increases if your child has:

  • Long-term asthma that is severe and does not respond well to treatment 
  • Asthma that worsens after eating, exercising, or lying down 
  • Frequent coughing or hoarseness

Hiatal hernia. A hiatal hernia means the top part of your child’s stomach rises above the diaphragm and into the chest. If your child has a hiatal hernia, he or she is more likely to develop GERD.

Slow digestion. If your child has slow digestion, food stays in the stomach for a long time before moving to the small intestine. This increases the chance that stomach contents will reflux into the esophagus.

Large meals. Having a large meal can cause the esophageal sphincter muscle to relax, which allows stomach juices to rise up (reflux) into the esophagus.

Certain foods. The following foods may worsen GERD symptoms in children and teenagers:

  • Fatty and fried foods 
  • Caffeinated drinks (coffee or soda) 
  • Citrus fruits (including tomatoes and tomato sauce) 
  • Spicy foods 
  • Chocolate 
  • Onions 
  • Garlic 
  • Peppermint 

Smoking and drinking alcohol also make GERD symptoms worse. Make sure your teenager understands the added dangers of using these substances when he or she has GERD.

Symptoms

Your child may experience one or more common symptoms of GERD. 

Frequent heartburn or chest pain. Heartburn feels like a burning sensation, warmth, or heat under the breastbone. This burning sensation may increase or decrease after eating and often gets worse when lying down or bending over. Even though it is called heartburn, this symptom has nothing to do with your child’s heart.

Acid regurgitation or a sour or bitter taste in the throat or mouth. This bitter or sour taste is backflow of acid and juices from the stomach. It often occurs along with heartburn, but in some cases it may be your child’s only symptom.

Swallowing problems. Although less common, your child may have a sore, raw throat when swallowing. Or your child might describe the sensation as food “getting stuck” on the way down.

Breathing problems. Your child may develop a chronic cough, wheezing, or worsening asthma. Children might also develop a hoarse voice or recurring episodes of pneumonia, although these are not common symptoms of GERD.

Possible Complications

Contact us if your child’s GERD symptoms last for more than 2 weeks. There are several long-term complications associated with recurring or untreated GERD.

Esophageal problems

The lining of the esophagus may become injured, causing pain or more severe complications, including bleeding or scarring.

Other problems

GERD may also cause problems outside the GI tract, such as: 

Respiratory problems. Severe GERD can cause persistent cough, asthma, or pneumonia. 

Structural changes of the lungs or voice box (larynx). Your child may develop a raspy, hoarse voice from inflammation in the larynx. 

Tooth decay. As stomach acid gets into the mouth, it can wear away at tooth enamel and cause tooth decay.

Diagnosis

To diagnose GERD, we may order the following medical tests or procedures: 

Acid reflux monitoring

This test shows how often stomach acid gets into the esophagus and how long it stays there. We gently insert a small plastic tube (catheter) that is 1 to 2-mm wide, or about the size of a single spaghetti strand, through your child’s nose into the esophagus. The catheter is taped in place, and a recording is taken over the next 24 hours. We might order this test if your child has unusual symptoms or is not responsive to GERD treatment. 

Upper gastrointestinal endoscopy

We use a thin, flexible tube called an endoscope to view the inner lining of your child’s esophagus, stomach, and upper small intestine (duodenum). The endoscope can identify changes to the esophagus, such as inflammation and wearing away (erosion) that might develop with GERD. Your child is sedated before we perform this procedure.

Prevention

The best ways to prevent GERD include maintaining a healthy weight, eating a healthy diet that avoids fatty foods, and learning how to cope with stress. 

Your child may be able to prevent GERD symptoms by eating smaller meals throughout the day and avoiding the foods that trigger symptoms such as heartburn. Have your child avoid eating at least 2 to 3 hours before bedtime. 

Have children wear loose clothing that isn’t too tight around their waist.

You can try raising the head of your child’s bed about 6 inches or having him or her lie on a wedge-shaped pillow to see if this reduces symptoms. For more information, including an illustration of this bed strategy, see Lifestyle Changes in the Treatment section. 

Treatment

Depending on your child’s symptoms, we may recommend a combination of lifestyle changes and medicines to reduce or block acid from forming in the stomach. 

In rare cases of GERD, we may recommend that your child have surgery to relieve severe or persistent symptoms. 

Lifestyle Changes

GERD can usually be managed through lifestyle and diet changes that relieve discomfort and pain. Have your child or teenager follow these general guidelines to reduce GERD symptoms. 

Eat smaller meals. Larger meals might trigger the esophageal sphincter muscle to relax, which allows stomach juices to rise up (reflux) into the esophagus.

Avoid late night snacks. Acid production is at its peak during the evening. It’s best to eat an early dinner and avoid evening snacks.

Avoid lying down for at least 2 to 3 hours after meals. Lying down after eating allows the acid to rise up into the esophagus.

Increase physical activity and encourage healthy eating. Being overweight or inactive can make GERD symptoms worse. If your child is overweight, talk with us about strategies for healthier eating and increased physical activity that can benefit the whole family.

Raise the head of your child’s bed about 6 to 8 inches. Try putting sturdy blocks under the bed frame legs. If you are unable to raise the bed, raise your child’s head (and upper body) by putting a foam wedge under his or her head and shoulders.

Avoid certain medicines. Anti-inflammatory drugs such as aspirin, ibuprofen (Advil), and naproxen (Aleve) and antibiotics such as doxycycline and minocycline, used for acne, can cause GERD or stomach ulcers. Let us know if your child is taking any of these medicines.

Avoid or limit certain foods. Chocolate, fatty or fried foods, peppermint or spearmint-flavored foods, coffee, alcohol, and carbonated drinks tend to make heartburn symptoms worse. Certain citrus fruits and juices (orange and tomato juice) can irritate the esophagus. Spicy foods can make heartburn symptoms worse.

Wear loose clothing. Tight-fitting belts or waistbands can squeeze the stomach and force food up against the lower esophagus.

Reduce stress. Stress can increase GERD symptoms. Consider your child’s schedule, demands on his or her time and performance, and stressors such as peer pressure or lack of sleep. See the Healthy Teens Online Newsletter article on Stress and Teens for strategies to help your teen manage stress. 

Drugs and alcohol. Exposure to certain substances, such as alcohol, cigarettes, and drugs, can cause GERD. If you think your child is using these substances, talk to us about how to recognize and deal with substance abuse and when to get professional help.

Medications

We may recommend that your child take a short course of medications; however, we strongly recommend that your child improve his or her diet and lifestyle habits before taking medications. Your child should continue healthy eating and lifestyle habits while taking medications. Do not give your younger child and infant any medicines before talking with us first. 

Your child may need to take medicines only while he or she experiences GERD symptoms. Once the symptoms go away, your child may be able to stop taking the medication. The following are common GERD medications:

Antacids (Maalox, Mylanta, Tums, and Gelusil). This type of medicine is the most commonly used for mild or occasional GERD symptoms. Antacids work by neutralizing stomach acid. Side effects include constipation and diarrhea. 

Histamine (H2) blockers (Pepcid AC, Tagamet HB, and Zantac). These medicines provide temporary relief by reducing stomach acid. They are helpful for about half of those with GERD. We may prescribe a stronger H2 blocker if one is needed. 

Proton pump inhibitors (Prilosec and Prevacid). This type of medicine reduces the amount of acid in your child’s stomach and heals the esophageal lining. We may recommend this medicine when H2 blockers fail to control symptoms. Side effects are not common but may include headache, stomach pain, bloating, diarrhea, and nausea.

Foaming agents (Gaviscon). This medicine coats the stomach lining with foam to prevent acid reflux. 

If your child fails to respond to over-the-counter medicines, or if he or she needs a liquid form, we may prescribe other medications.

Surgery

In rare instances, a child may continue to have severe acid reflux even after being treated with medicine and lifestyle changes. If your child develops complications, such as failure to gain weight (also called failure to thrive), esophagitis that does not improve with medication or that is associated with a narrowing of the esophagus, or damage to the lungs, surgery (called fundoplication) may be needed. 

If we do recommend surgery, we can discuss any questions or concerns you might have and talk about the risks and the benefits of surgery for treating your child’s specific health issues. 

When to Call Us

Call us if your child experiences any of these symptoms:

  • GERD symptoms lasting longer than 2 weeks
  • Difficulty swallowing
  • Blood in the throat or in a tissue after coughing
  • Hoarse voice 
  • A respiratory infection, such as pneumonia or bronchitis
  • Chronic cough, wheezing, or worsening asthma
  • Loss of appetite or failure to gain weight as expected

Call the Appointment and Advice line immediately if your child starts vomiting blood or notices bloody or dark tarry stools. 

Call 911 or seek urgent care if your child has breathing difficulties. 


If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following:
(1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.

This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.