Many of the complications below can also be
symptoms or indications that an undiagnosed baby or child has GERD.
Not all are common in babies or children, but they are all possible if
GERD is left untreated for a long period of time.
failure to thrive
Newborns and young infants are expected to grow at a steady and
predictable rate, much more rapidly than they will as they get older.
Within the acceptable limits of weight gain, there are those that fall
in the high end and those that fall in the low end.
Sometimes; however, babies will not gain weight at an acceptable or
safe rate and fall below even the low end of the scale. These babies
are labeled as failure to thrive.
Failure to thrive is a general term, and can have many different
causes. Causes of failure to thrive tend to be classified as organic
(an underlying health issue), or inorganic (external reasons, for
example the caregiver). Failure to thrive caused by GERD is classed
as organic and is in no way the fault of the caregiver.
GERD can cause failure to thrive a few ways. Even with the most
enthusiastic eaters, frequent or constant vomiting of entire feeds
will make weight gain, or even maintaining current weight, difficult
or impossible. Even if vomiting isn't present, some babies will begin
to associate food with pain and unpleasantness from their reflux and
they will begin to develop aversions to eating. They will actually
refuse their meals making it difficult to obtain weight gains.
Although there are some things that can help with feeding a stubborn
eater, these tricks will work with some children, others actually
require tube feeding to gain weight and survive. What's the old
saying about leading a horse to water...? Read More About Failure To Thrive ╗
Sometimes journaling your child's food intake can help you keep
better track of their caloric intake and can help with failure to
thrive. Print our free journal pages ╗
food and oral aversions
As touched on above, associations made by the baby between food and
pain can cause some to become difficult to feed, or even stop eating
altogether. As a parent, this can be one of the more frustrating
complications since some children are so fearful of food nothing short
of tube feeding can provide the nourishment required. The draw backs
of short term tube feedingŚ those inserted
through the noseŚcan unfortunately be food and
oral aversions. Inserting feeding tubes can reinforce baby's bad
feelings about anything going into their mouth, as they can have a
difficult time separating the two areas of the face.
Babies and children with GERD seem to have a stronger gag reflex
than other children and may gag and choke on their food frequently.
They may also gag and choke throughout the day for no apparent reason,
this is likely from refluxed material coming part of the way up,
perhaps into the throat enough to cause a gag, or into the airways
enough to temporarily block airflow.
Apnea refers to an period of more than ten to twenty seconds of
interrupted breathing. Children with GERD are susceptible to apnea
episodes because refluxed material can block the airways, preventing
aspiration and aspiration pneumonia
Aspiration is when food or refluxed material is allowed to enter
the lungs. The damage done to the lungs (if any) is determined by the
characteristics and amount of aspirated material. The more acidic it
is, the more severe the injury to the lungs. Aspiration itself won't
cause pneumonia, if the lungs become infected from the aspirated
material, pneumonia can occur.
It's suggested that more than 75% of people (of all ages) with
asthma also have reflux or GERD and those who have asthma are twice as
likely to have GERD as those who don't.
Read more about the asthma / reflux connection>.
chronic cough, hoarseness or laryngitis
Just as acid refluxed from the stomach can damage the esophagus and
lungs, it can damage the throat and vocal cords. In some cases this
can be the only symptom of GERD, making it more difficult to diagnose.
dysphagia and strictures
Dysphagia means difficulty swallowing. The main cause of dysphagia
from reflux is severe scarring in the esophagus (strictures) from
constant acid exposure. The scar tissue is thicker than the normal
lining of the esophagus causing strictures that can basically clog the
esophagus and prevent food and even liquids from passing through.
Although rarely does it get this severe in infants it is possible if
Inflammation of the esophagus caused by frequent contact with
Anemia is caused by blood loss and is defined as a drop in
hemoglobin count (distributes oxygen to the body's cells and carries
carbon dioxide back to the lungs). Reflux can cause anemia by eating
away the esophagus until it begins to bleed. Like the strictures, it
would be rare for it get this extreme in infants, but again, if left
untreated, it's possible.
eroded dental enamel
Stomach acid entering the mouth can erode teeth, just as it does
the esophagus, throat, vocal cords, etc.
This occurs when cells in the esophagus change in an attempt at
protecting themselves against constant acid exposure. The stomach is
protected from the acid it produces by special cells called columnar
epithelium cells. The esophagus has more delicate cells called
squamous epithelium which are not designed to protect against acid.
When it becomes chronically burned and damaged from acid exposure,
these delicate squamous epithelium cells attempt to protect themselves
against further damage by replacing the squamous epithelium cells with
a special type of cell similar to the columnar epithelium cells found
in the stomach. It is unknown why, but these changes are
pre-cancerous. This is not likely to occur in infants, it takes long
term acid exposure for this to occur.
Years of untreated GERD can eventually result in esophageal
cancer. It is said that the survival rate is low because symptoms
usually only appear after it has progressed to other areas of the
Reviewed By Dave Olson, MD
Fellow, American Academy of Pediatrics
Graduate University of Michigan School of Medicine