Symptoms & Causes of GER & GERD in Infants

What are the symptoms of GER and GERD in infants?

In infants, gastroesophageal reflux (GER) commonly causes

• regurgitation, or stomach contents coming back up through the esophagus and into the throat or mouth
• spitting up

Infants with gastroesophageal reflux disease (GERD) may have regurgitation and spitting up along other signs and symptoms, such as

• arching of the back and abnormal movements of the neck and chin
• choking, gagging, or problems swallowing
• irritability, particularly when it occurs with regurgitation
• loss of appetite or refusing to eat
• complications, such as poor weight gain, cough, or wheezing
• vomiting

However, many conditions other than GERD can cause similar symptoms. Doctors may recommend tests to check for other health problems before diagnosing GERD.

Call a doctor right away if an infant has signs or symptoms that could be related to a serious health problem other than GERD. Examples include

• crying more than usual or being extremely irritable
• failure to thrive, meaning that an infant or a child weighs less or is gaining less weight than expected for his or her age
• problems breathing
• problems swallowing
• signs of bleeding in the digestive tract, such as
  • vomit that contains blood or looks like coffee grounds
  • rectal bleeding or stool that contains blood
• signs of dehydration, such as no wet diapers for 3 hours or more, or a lack of energy
• vomiting
  • in large amounts
  • that is regularly forceful, also called projectile vomiting
  • with bile in the vomit, which makes the vomit green or yellow in color
• vomiting or regurgitation that begins when an infant is younger than age 2 weeks or older than age 6 months³

What causes GER & GERD in infants?

Experts think several factors lead to GER in infants. For example, in the first 6 months of life, infants spend much of their time lying down and do not have a fully developed esophagus and lower esophageal sphincter.^4,5 They also eat meals that are primarily liquid and larger, relative to their body size, than older children or adults do. These factors make it more likely that stomach contents will come back up into the esophagus. As infants spend more time upright, eat more solid foods, and grow and develop, they typically experience less GER.

As infants grow and develop, they typically experience less GER.

Experts are still studying why some infants develop GERD—a condition in which GER causes repeated symptoms that are bothersome or leads to complications. Several different factors may play a role. For example, infants with GERD may have problems with how the lower esophageal sphincter works, have more acid reflux, or feel more discomfort when GER occurs.

Infants are more likely to have GERD if they have certain health conditions, including

• being born prematurely
• conditions that affect the lungs, such as cystic fibrosis
• conditions that affect the nervous system, such as cerebral palsy
• hiatal hernia, a condition in which the opening in the diaphragm lets the upper part of the stomach move up into the chest
• previous surgery to correct esophageal atresia, a type of birth defect

References

[3] Gonzalez Ayerbe JI, Hauser B, Salvatore S, Vandenplas Y. Diagnosis and management of gastroesophageal reflux disease in infants and children: from guidelines to clinical practice. Pediatric Gastroenterology, Hepatology, and Nutrition. 2019;22(2):107–121. doi:10.5223/pghn.2019.22.2.107

[4] Pados BF, Davitt ES. Pathophysiology of gastroesophageal reflux disease in infants and nonpharmacologic strategies for symptom management. Nursing for Women’s Health. 2020;24(2):101–114. doi:10.1016/j.nwh.2020.01.005

[5] Chabra S, Peeples ES. Assessment and management of gastroesophageal reflux in the newborn. Pediatric Annals. 2020;49(2):e77–e81. doi:10.3928/19382359-20200121-02