What Is Acid Reflux?
Acid reflux occurs when the lower esophageal sphincter (LES) does not close properly, causing stomach contents to back up, or reflux, into the esophagus. The liquid mixture of acid and pepsin which leaks into the esophagus can be very irritating, causing inflammation and even damage in rare cases. Pepsin, the enzyme that begins the digestion of proteins in the stomach, may also be accompanied by bile that has been backed up in the stomach from the duodenum—part of the small intestine that attaches to the stomach. But the acid is the most dangerous part of this mixture, as it can eat away at the esophagus lining.
While occasional heartburn is common, heartburn that occurs more than twice a week may be considered GERD—Gastroesophageal Reflux Disease—and can eventually lead to more serious health problems, according to the National Institutes of Health (NIH). You may be surprised to learn that anyone, including infants, children, and pregnant women, can have acid reflux and be in danger of developing GERD.
Acid Reflux in Infants
It is estimated that at least half of all newborns—and up to 85 percent of premature infants—are born with some degree of infant reflux. “GERD is very common among infants,” says best-selling author and noted physician Dr. Andrew Weil, MD, “but most outgrow it by the time they reach their first birthday, and it is rare for GERD to continue past the age of two.”
Because reflux can become a more serious concern in some infants, even requiring medical attention, it is important to know the symptoms of chronic reflux. The NIH suggests you look for the following signs:
- poor feeding
- blood in the stool
If your baby exhibits signs of reflux, be sure to track her carefully. If she develops any of the advanced symptoms below, call your pediatrician immediately:
- vomiting large amounts, or persistent, forceful vomiting (especially if your child is under two months old)
- vomiting fluid that is green or yellow or looks like coffee grounds or blood
- difficulty breathing after vomiting or spitting up
- excessive irritability related to feeding, or refusing food (and accompanying weight loss or poor weight gain)
- difficulty swallowing or painful swallowing
Your doctor may recommend simple strategies for avoiding reflux. Here are some tips used successfully by many parents:
- Burp your infant several times during feedings or keep him in an upright position for 30 minutes after feeding.
- If your baby is bottlefed, add up to one tablespoon of rice cereal to two ounces of infant milk (including expressed breast milk). If the mixture is too thick for your infant, you can change the nipple size or cross cut the nipple.
- Always burp your baby after he or she drinks one or two ounces of formula. For breastfed infants, burp after feeding on each side.
- Do not overfeed. Talk to your child’s doctor or nurse about the amounts of formula or breast milk that your baby is eating.
- When possible, hold your infant upright in your arms for 30 minutes after feeding.
- Infants with GERD should usually sleep on their backs, as is suggested for all infants, but sometimes a physician may suggest another sleep position.
If these techniques don’t ease your baby’s symptoms, your child’s doctor or nurse should discuss GERD with you in depth and suggest possible treatments to relieve your little one’s reflux.
Acid Reflux in Children
Studies conducted by Dr. A.D. Jung, MD, and published in the 2001 American Family Physician, show that acid reflux is common in children, but is often overlooked despite its symptoms (vomiting, coughing, and other respiratory problems). Children’s immature digestive systems are usually to blame, says the NIH, adding that most children outgrow the problem. Parents should speak with their child’s pediatrician if symptoms occur regularly or if your child appears often uncomfortable.
Children may exhibit the following symptoms of acid reflux:
- hoarse or raspy voice
- chronic cough
- recurrent pneumonia
- difficult or painful swallowing
Parents can help their children deal with acid reflux by watching their diet. If your child is experiencing acid reflux, it may help to cut back on certain foods that often act as triggers. Consider greatly reducing or eliminating the following items from your child’s diet:
- citrus fruits
- drinks with caffeine
- fatty and fried foods
- garlic and onions
- mint flavorings
- spicy foods
- tomato-based foods such as spaghetti sauce, chili, and pizza
Also recommended for both adults and children is to avoid eating two to three hours before bedtime. You can also elevate your or your child’s head with pillows, or even slightly raise the head of the bed, to alleviate nighttime heartburn and GERD.
If these tactics don’t decrease your child’s symptoms, be sure to make an appointment with your child’s pediatrician. Further treatment may be necessary to help your child be more comfortable and to prevent damage to his or her esophagus.
Acid Reflux in Adults
According to an article in the September 2003 Journal of General Internal Medicine, one-fourth of adults in developed countries experience heartburn monthly, and five percent suffer from heartburn daily.
No one knows why people get acid reflux or GERD, but in some cases a hiatal hernia may be a contributor. A hiatal hernia occurs when the upper part of the stomach is above the diaphragm (the muscle wall that separates the stomach from the chest). The diaphragm helps the LES keep acid from coming up into the esophagus. When a hiatal hernia is present, it is easier for the acid to come up, thus causing reflux. Although a hiatal hernia can happen in people of any age, many otherwise healthy people over age 50 have a small one.
Other factors that may contribute to adult acid reflux and GERD include:
- alcohol use
- being overweight
- restrictive clothing in the midsection
You can potentially alleviate symptoms of acid reflux by not eating or drinking anything within two hours of your bedtime and by decreasing your meal size and frequency. Some physicians suggest eating six small meals each day instead of three big meals. This tactic prevents your stomach from getting too full and uncomfortable and reduces gastric pressure. When you do eat, eat slowly to prevent additional stomach upset.
Over-the-counter antacids are sometimes effective in relieving heartburn, but if you find no relief using home remedies and antacids, you may want to explore a prescription alternative with your doctor. There are many new options on the market, and your physician can help you decipher which will be best for you.
Acid Reflux in Pregnancy
During pregnancy, the body experiences myriad hormonal and physical changes—and many women who don’t otherwise have heartburn suddenly experience symptoms. This is due in part to the increased levels of the hormone relaxin, which softens the ligaments that normally keep the valve between the esophagus and stomach clamped shut. The pressure of the growing baby against your stomach can also contribute to heartburn and acid reflux.
In addition to avoiding food triggers and eating smaller meals, pregnant women can try eating yogurt or drinking a glass of milk to quell heartburn. A popular home remedy that works for many moms-to-be is to drink a glass of warm milk with a tablespoon of honey stirred in.
If symptoms persist, speak with your physician about trying an over-the-counter or prescription antacid. Although antacids are considered safe during pregnancy, some contain sodium and even trace amounts of lead. Your physician can help you choose a pregnancy-safe medication.