Acid reflux, also known as acid indigestion, is a common condition that affects nearly everyone at some point in their lives. Acid reflux is known as gastroesophageal reflux disease, or GERD, when it becomes frequent or chronic. Acid reflux occurs when the lower esophageal sphincter (LES)—the muscle that acts as a valve between the esophagus and the stomach—either relaxes or doesn’t close properly. This allows stomach contents including acidic digestive juices to back up into the esophagus.
Over time, GERD may result in more serious health problems, such as bleeding and ulcers (esophagitis), narrowing of the esophagus (strictures), or Barrett's esophagus (a condition in which the cells of the esophageal lining become damaged). Barrett's esophagus may lead to esophageal cancer, which can be fatal.
The most common symptom of both acid reflux and GERD in adults is a burning sensation in the chest or throat known as heartburn. However, one group that almost never experiences heartburn as a symptom of acid reflux is kids. Infants and children with the condition often present asthma symptoms, a dry cough, or trouble swallowing. This can make GERD in children extremely difficult to diagnose and properly treat.
Often, medications used to treat acid reflux and GERD can contribute to other digestive problems, including constipation. Between misdiagnosis, incorrect treatments, and the unintended side effects of certain medications, constipation is often an unfortunate consequence of acid reflux in children.
Acid Reflux and Constipation in Children
Acid reflux is a normal part of life for infants up to the age of one. Babies will often spit-up or vomit with no ill effects. However, if symptoms persist after one year, there may be cause for concern. As very young children are unable to communicate their symptoms, parents need to be on the lookout for the following signs of GERD:
- arching of the back (either during or immediately following meals)
- poor growth
- refusal to eat
- repeated regurgitation
- respiratory problems such as asthma, pneumonia, or wheezing
Contact your child's health care provider if symptoms occur regularly. They may recommend some fairly easy remedies, such as: raising the head of the child's bed six to eight inches (by placing wood blocks under bedposts), burping infants several times during feedings, or keeping them in an upright position for 30 minutes after eating. Parents of older kids may be advised to feed them smaller, more frequent meals. You also should avoid serving foods such as:
- caffeinated sodas
- citrus fruits
- fried and fatty foods
- mints such as peppermint or spearmint
- spicy foods
- tomato-based foods, including pizza and spaghetti sauce
Medications and Their Side Effects
The next line of attack in the battle against acid reflux is medications such as proton pump inhibitors (PPIs). This is where the problem of constipation comes in, according Dr. Ghassan Wahbeh, director of the inflammatory bowel disease program at Seattle Children's Hospital. Proton pump inhibitors, including popular brands, such as Nexium and Prilosec, are extremely effective in treating GERD in adults. However, they may have unintended consequences for children, Dr. Wahbeh says. One of the most under-recognized conditions that masks as GERD in children is functional constipation—and constipation is one of the side effects of PPIs.
Because pain location in constipated children varies, it's often misdiagnosed as GERD, according to Dr. Wahbeh. "Epigastric pain [in the upper, central part of the abdomen] does not mean gastroesophageal reflux. The presumed relation of epigastric pain to gastroesophageal reflux is unproven," he says. In addition to the high costs of PPIs (which can cost several hundred dollars per month), there's also a risk of the over-secretion of stomach acids once treatment is stopped. This can cause acid reflux in misdiagnosed children who didn't have the condition in the first place.
Dr. Wahbeh suggests blood panels to rule out other conditions such as anemia, celiac disease, and functional abdominal pain or functional constipation before trying a prescription medication for GERD. Otherwise, these medications might exacerbate pain in children and create frustration for their parents and doctors.