Gastroesophageal Reflux Disease (GERD) in Children

Definition

GERD in children is a condition in which gastric contents reflux into the esophagus, causing troublesome symptoms or complications such as esophagitis, feeding difficulties, or respiratory problems.

Epidemiology

• Physiologic reflux is common in infants, affecting up to 50% of healthy infants under 6 months
• Pathologic GERD is less common, affecting approximately 2–7% of children
• Higher prevalence in children with neurologic impairment, prematurity, or congenital anomalies
• Incidence decreases with age as the lower esophageal sphincter matures
• No strong sex predilection

Etiology

• Immature lower esophageal sphincter (LES) tone in infants
• Delayed gastric emptying
• Increased intra-abdominal pressure (obesity, coughing, constipation)
• Hiatal hernia
• Neurologic impairment or developmental delay
• Dietary factors (overfeeding, certain formula types)
• Medications that relax LES (e.g., theophylline, anticholinergics)

Pathophysiology

• Transient LES relaxation or hypotonia allows gastric contents to reflux
• Acidic contents irritate the esophageal mucosa causing inflammation (esophagitis)
• Reflux episodes can trigger protective reflexes (cough, arching, vomiting)
• Chronic reflux may lead to mucosal injury, strictures, Barrett’s esophagus, or respiratory complications
• Delayed gastric emptying exacerbates reflux
• Neurologic impairment can reduce clearance and increase severity