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Column originally published Dec 19, 2006

Reflux Can Happen To Older Children Also

Question: Our three-year-old son had a reflux problem as a young infant. I nursed him for a full year. When he was two months old, he started to cry all the time, and arched his back when I was nursing him. Our doctor made the diagnosis of reflux even though he didn’t spit up more than our older child. The medicine he prescribed made a big difference, our son became much more content, and there was no crying spell any more. We stopped the medicine when he was about 8 months old. He was well until about a year ago, when I had another baby. The day I went to the hospital to deliver this baby, our son woke up in the middle of the night and vomited. Since then, he has bouts of vomiting, even though he is otherwise healthy. I am due to go back to work soon. Last week, he started complaining that he was full in the middle of each meal, and started vomiting shortly after. He also woke up every night complaining of belly pain and then vomited. He threw up so much he started refusing food. We were concerned and took him to see our doctor. After listening to our concern and checking him thoroughly, our doctor said that his reflux is back and gave him ranitidine again. We were skeptical at first, but our son has improved with the medicine. I have heard of adults getting reflux problem, but I don’t know that young children can get it too.


From what you have described here, your son likely has a reflux problem that was always there, although it didn’t affect him again until last year. It is actually not an uncommon problem. Let me explain to you in greater detail here.

Reflux, also known medically as gastro-esophageal reflux disorder (GERD), is a common condition that is under-recognized most of the time. In adults, it presents with pain behind the sternum (or breast bone), as well as the feeling of acidic fluid in the throat. Many adults recognize this acid reflux problem especially when they are highly stressed. It seems that stress can increase acid production in the stomach.

To understand GERD better, you need to know a little more about the upper digestive system in our body. When we swallow food, it goes from the mouth through a long tube called esophagus before entering the stomach. At the lower end of the esophagus, there is a muscle that acts as a sphincter to control the entrance of the stomach. When food reaches the lower end of esophagus, this sphincter relaxes and allows food to enter the stomach. Immediately afterwards, the sphincter clamps down again so that food and stomach juice cannot go backwards into the esophagus.

In those people who have GERD, this sphincter doesn’t work properly. As a result, stomach juice gets into the esophagus, causing irritation and pain that many GERD sufferers experience.

In young infants, this sphincter is weaker than in adults, so that babies can burp and expel air that they normally swallow while nursing or drinking from a bottle. That is why all babies spit up some milk especially when they are being burped. This mild reflux is completely normal in most babies and should not cause any concern.

Unfortunately, a small number of infants develop a lot of pain as a result of this reflux. For reasons that are still unclear, some babies seem to produce more acid in their stomach than others. They usually do not have problem until one to two months after birth, when acid production starts to increase in the stomach. When the acidic stomach content goes up the esophagus, either during or shortly after the baby finishes a feeding, the pain can cause him to cry excessively and arch his back. Many of them cry both day and night. We now recognize that many colicky babies actually have GERD as an infant.

Ranitidine is a safe medicine for acid reflux even in very young infants. Production of acid in the stomach depends on a chemical called histamine. Ranitidine blocks one of the histamine receptors so that less acid will be produced by the stomach. Most babies improve when given this medicine two to three times a day. If it doesn’t work, a new class of medicine called proton-pump inhibitor has also been used.

Most babies with acid reflux improve between 6 to 12 months of age, when they sit up more, and start eating solid food. As in your son’s situation, you were able to stop the medicine at that time.

A small number of these children, however, can develop reflux problem again later on in life, if there is excessive acid production. Most of the time, this occurs in situations when the child is being stressed. We don’t know why GERD symptoms occur in some children or adults, but not in others. It may have something to do with their temperament, so that stress causes them to produce more acid in the stomach than others, to the point of producing acid reflux disease.

I hope you have a better understanding of acid reflux and how it can affect your son. You should monitor his condition and consult with your doctor often. Many children need to continue their medicine for several months. You should watch your son’s temperament, because he may need additional help in future to deal with stresses that he will encounter in his life.  He may be more prone to anxiety.