Gastroesophageal Reflux Disease

What is gastroesophageal reflux?

“Reflux” means “backwards movement.” The esophagus is the tube that leads from the mouth to the stomach. So gastroesophageal reflux is the backwards movement of food and acid from the stomach into the esophagus.

Burping, and spitting up are common after a baby feeds. Most babies spit up to some degree without discomfort and it usually fades by the first or second year. This is called gastroesophageal reflux (without “disease”).

Gastroesophageal reflux disease (GERD) occurs when there are symptoms of discomfort, or poor weight gain.

Older children and adolescents may also get GERD.

Signs and symptoms of GERD

In a baby, symptoms of GERD may include:

  • effortless spitting up of food or feedings with discomfort
  • coughing, when regurgitated food gets into the trachea (breathing tube)
  • irritability before feeding; the baby will arch back, twist her neck, or pull away from feeding
  • crying before or during feeding
  • poor weight gain

In older children, signs and symptoms may include:

  • dental cavities, caused by stomach acid
  • heartburn
  • a sour taste in the mouth
  • stomach and chest discomfort

Causes of GERD

GERD occurs when the lower esophageal sphincter, which sits at the connection between the esophagus and the stomach, fails to properly close or relaxes incorrectly. This faulty valve allows food to travel all the way up the esophagus, causing “spit-up.” When the food only travels partly up the esophagus, it may cause a burning sensation.


Repeated exposure to stomach acid can lead to complications in some infants and children with GERD. These complications can include:

  • poor weight gain or weight loss
  • bleeding in the esophagus
  • difficulty breathing or swallowing
  • irritation of the esophagus (esophagitis)

How a doctor can help your child

Since vomiting and regurgitation are very common in babies in the first years of feeding, the doctor will need to determine whether the condition is simply GER (without ‘D’) or severe enough to warrant a GERD diagnosis and the relevant treatment. There are numerous ways your child’s doctor can diagnose GERD.

Barium swallow

This test requires the infant to drink barium, a chalky white liquid that shows the functioning of the esophagus, sphincter, and stomach in X-ray images. The flow of the liquid is shown in X-ray pictures and allows the doctor to observe any mechanical problems.

This is not the best way to diagnose GERD. If an infant does not reflux during the test, it does not mean that she does not have GERD.

pH probe

In the pH probe, a small wire with an acid sensor is placed through the baby’s nostril, passed down the esophagus, and rests just before the entry of the stomach near the lower esophageal sphincter. The probe monitors how often the lower esophagus is exposed to the backward-flowing stomach contents and how long this lasts.


Rarely, the doctor will order an inspection of the esophagus and the stomach using an endoscope while your child is asleep under anaesthetic. An endoscope is a small instrument inserted through the mouth or nose that allows the doctor to see the tissue using a tiny fibre-optic camera. During the procedure, doctors may also biopsy a small sample of the lining of the esophagus to determine the cause of the symptoms.

What you can do to help your child with gastroesophageal reflux

Most children outgrow the symptoms of GERD, but some children require treatment. There are few steps you can take to help ease the symptoms at home.

Raise head

Hold your child in an upright position after feeding. Sitting slumped in a chair or swing can increase the pressure on the stomach and can cause more reflux.

Raise the head of the crib or bed by 30 degrees so that your child’s head is higher than his feet while sleeping. 

Thicken food

Speak to your child’s doctor about thickening your baby’s formula with infant cereal. This has been shown to reduce the severity of regurgitation, and the increased nutrition helps make up for lost caloric intake if the baby was not feeding well.

Avoid certain foods

Older children should avoid certain foods that are more likely to worsen reflux. These foods include soda and pop, coffee, tomato-based products, citrus fruits, mint, and spicy foods. Antacids can also relieve the indigestion or heartburn in older children.

When to seek medical assistance

Make an appointment with your child’s doctor if your child:

  • is failing to gain weight because of poor feeding sessions
  • is crying or extra irritable during feedings or while spitting up (effortless and painless spitting up is usually not a problem if gaining weight)
  • coughs during or after feeds

Key points

  • Most babies experience some regurgitation after feeding.
  • Most children outgrow symptoms of GERD by the time they can eat solid foods.
  • Gastroesophageal reflux disease (GERD) occurs when the irritable and painful symptoms are frequent and persistent or leads to poor weight gain.
  • Complications can include bleeding in the esophagus or difficulty breathing.

Mark Feldman, MD, FRCPC


Chang AB, Lasserson TJ, Gaffney J, Connor FL, Garske LA. Gastro-oesophageal reflux treatment for prolonged non-specific cough in children and adults. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD004823. Last accessed March 2010.