Gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD) are often thought of as conditions only affecting adults. They occur when acid moves backwards from the stomach into the oesophagus.  

However, as any new parent will know, young babies often struggle with reflux during their first few months. Usually, this problem resolves without any intervention. GER and GERD can persist in older children and teens – in such cases, the symptoms of GERD in children are similar to adults.  

Symptoms of GER and GERD in Children 

The symptoms of GER and GERD in children differ depending on the age of the child. Broadly speaking, we can separate them into infants and young children or older children and teens. The primary difference is the communication barrier. The younger the child, the less able they are to express discomfort or describe their symptoms. 

Infants and Young Children 

Fundamentally, the underlying condition remains the same regardless of the child. GER is relatively common in this age group, peaking at around 4 months old and improving until 12-18 months.  

Common symptoms include: 

• Frequent spitting up or vomiting (especially after feeds) 

• Fussiness during or after feeding 

• Hiccups 

• Coughing or gagging during feeding 

• Arching of the back (especially during or after feeding) 

• Refusing to feed or difficulty feeding 

• Mild sleep disturbances 

• Normal weight gain despite symptoms 

If the reflux is severe (i.e., GERD), then a child may experience poor weight gain (or even weight loss), refusal to eat, blood in vomit or stool, disrupted sleep, and chronic coughing, wheezing, or other breathing issues. Children who are starting to vocalise and eat solids may have a hoarse voice or difficulty swallowing.  

Older Children and Teens 

There is no cutoff between the symptoms above and those listed below. Indeed, there’s significant overlap between the symptoms. What differs is the ability of the child to articulate their problems and manage their response to them.  

The symptoms of GERD in older children gradually appear more similar to those of adults. Your child might complain about: 

• Heartburn or chest pain 

• Sour-tasting regurgitation 

• Chronic cough or throat clearing 

• Sore throat or hoarseness 

• Nausea after eating 

• Trouble swallowing 

• Bad breath 

• Bloating or frequent burping 

• Poor appetite or weight loss 

Sleep can also be disrupted, especially if they’re eating an hour or so before bed. However, it’s unlikely to cause the same level of sleep disruption as in infants. If the GERD persists, asthma-like symptoms or worsening asthma might become a problem.  

When to Seek Medical Attention 

For new parents, it’s sensible to speak to a doctor if their child is experiencing either GER or GERD. It’s smart to get them checked out early. More experienced parents will know the normal signs of GER. 

If your child experiences any more severe symptoms, seek immediate medical attention. These include: 

• Difficulty breathing 

• Difficulty swallowing 

• Refusing to eat, leading to weight loss or poor growth 

• Blood in either the stool or vomit 

• Persistent dehydration 

• Excessive vomiting (especially if it's projectile or green or yellow, i.e., bile) 

What Causes GER and GERD in Children? 

Perhaps the biggest difference between GER and GERD in children and adults is the underlying cause. In young infants, GER occurs due to the short length of the oesophagus and an immature lower oesophageal sphincter (LOS). 

Foods and liquids can easily leave the stomach, entering the oesophagus and mouth. New parents may also overfeed their child – the stomach is only small and becomes full quickly. Finally, infants spend much of their time lying down, which makes it easier for the stomach contents to come back up. 

As young children grow up, these problems begin to diminish. By 12-18 months, most symptoms of GER should disappear. If they persist, speak to your doctor. 

Older children and teens experience GERD for reasons similar to those of adults. These include: 

• Being overweight or obese 

• Smoking or inhaling second-hand smoke 

• Hiatus hernia (a condition where the upper part of the stomach enters the chest through an opening in the diaphragm) 

• Previous surgery (e.g., oesophageal atresia correction) 

• Large meals and a fatty diet 

• Stress or anxiety 

In addition to the causes, conditions like cerebral palsy or cystic fibrosis increase the risk of GERD in children. 

Want to learn more about GERD symptoms in children? The Functional Gut Clinic has numerous resources covering everything you need to know about the condition. Our comprehensive guide is the perfect introduction to GERD and acid reflux. We also offer diagnostic testing for people of all ages.