Reflux in Children

What is reflux (GER) and GERD?

Gastroesophageal reflux (GER), often called reflux, occurs when food or stomach acid flows back from your child's stomach into the esophagus. The esophagus is the tube that carries food from your mouth to your stomach. This can sometimes cause irritation or a burning sensation. Occasional reflux is common and usually not a problem.

Gastroesophageal reflux disease (GERD) is a more serious and long-lasting type of reflux. GERD can cause repeated symptoms or damage to the lining of the esophagus. Having reflux two or more times a week may be a sign of GERD. Your child's health care provider may diagnose GERD if the reflux causes pain, feeding problems, or irritation of the esophagus.

A small muscle called the lower esophageal sphincter acts as a valve between the esophagus and stomach. When your child swallows, this muscle relaxes to let food pass from the esophagus to the stomach. This muscle normally stays closed, so the stomach contents and acid don't flow back into the esophagus. This muscle, along with the diaphragm (the large muscle between the chest and abdomen), usually prevents reflux. It's normal for children to have reflux occasionally.

In children who have GERD, the lower esophageal sphincter may be weak or relax when it shouldn't. That allows stomach contents into the esophagus. This can happen because of:

• A hiatal hernia, a condition in which the upper part of the stomach pushes up into the chest
• Increased pressure on the abdomen (belly) from being overweight or having obesity
• Certain medicines, such as some used to treat asthma, allergies, depression, or pain
• Smoking or exposure to secondhand smoke
• Previous surgery on the esophagus or upper abdomen
• Developmental delays or certain neurological conditions, such as cerebral palsy
• Lung conditions, such as cystic fibrosis

Many children have occasional reflux, especially after large meals or physical activity. GERD is less common, and most symptoms improve with time and lifestyle changes.

Symptoms may vary by age. Some children might not even notice reflux, while others may taste food or stomach acid in the back of their mouth.

In children, GERD can cause:

• Heartburn, a burning feeling in the chest or throat (more common in older children and teens)
• Bad breath
• Nausea or vomiting
• Trouble or pain when swallowing
• Cough, hoarseness, or breathing problems
• Wearing away of tooth enamel from stomach acid

Other conditions can cause similar symptoms. Talk to your child's provider if symptoms happen often or make eating, sleeping, or daily activities difficult.

In most cases, your child's provider can tell if it's reflux by learning about your child's symptoms and health history. Tests are usually needed only if symptoms don't get better with lifestyle changes or medicines, or if another health problem is suspected.

Common tests include:

• Upper GI series, which looks at the shape of your child's upper GI (gastrointestinal) tract. Your child will drink or eat a chalky-tasting liquid called barium. For young children, the barium is mixed in with a bottle or other food. Several x-rays are taken to track the barium as it goes through your child's esophagus and stomach.
• Esophageal pH and impedance monitoring, which measures the amount of acid or liquid in your child's esophagus. A thin flexible tube is placed through their nose into the stomach. The end of the tube in the esophagus measures when and how much acid comes up into the esophagus. The other end of the tube attaches to a monitor that records the measurements. Your child will wear the tube for 24 hours. They may need to stay in the hospital during the test.
• Upper gastrointestinal (GI) endoscopy and biopsy, which uses an endoscope, a long, flexible tube with a light and camera at the end of it. An endoscope is inserted down your child's esophagus, stomach, and first part of the small intestine. While looking at the pictures from the endoscope, tissue samples (biopsy) may be taken.

Simple lifestyle changes can often improve symptoms. Examples include:

• Maintaining a healthy weight.
• Eating smaller meals.
• Avoiding high-fat foods or other trigger foods that cause symptoms.
• Wearing loose-fitting clothing around the abdomen (belly).
• Staying upright for 3 hours after meals and avoiding slouching when sitting.
• Sleeping with the head of the bed raised 6 to 8 inches.

If lifestyle changes aren't enough, your provider may recommend medicine to reduce stomach acid. The medicines work by lowering the amount of acid your child's stomach makes. Some are available over-the-counter, while others need a prescription. Do not give your child any medicine unless your provider recommends it.

If symptoms don't get better or are severe, your provider may refer you to a doctor who treats stomach and digestion problems in children. In rare cases, surgery may be considered.

If GERD isn't treated, it can cause problems such as inflammation or scarring in the esophagus, changes in its lining (Barrett's esophagus), or make breathing problems, like asthma, worse.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Reflux in Infants

What is reflux (GER) and GERD?

Gastroesophageal reflux (GER), often called reflux or spitting up, happens when food or milk comes back up from your baby's stomach into the esophagus. The esophagus is the tube that carries food from your mouth to your stomach. Reflux is very common in healthy babies. It usually starts to get better by 6 months of age and goes away by 12 months. Reflux that continues after 18 months is unusual.

Gastroesophageal reflux disease (GERD) is a more serious and long-lasting type of reflux. It can cause feeding problems, discomfort, or other symptoms that affect your baby's growth or sleep. Babies may have GERD if symptoms prevent them from feeding well or last longer than 12 to 14 months.

There is a muscle (the lower esophageal sphincter) that acts as a valve between the esophagus and stomach. When your baby swallows, this muscle relaxes to let food pass from the esophagus to the stomach. This muscle normally stays closed, so the stomach contents don't flow back into the esophagus.

In babies who have reflux, this muscle is not fully developed and lets the stomach contents back up the esophagus. This causes your baby to spit up (regurgitate). As your baby grows and the sphincter muscle fully develops, your baby should no longer spit up.

In babies who have GERD, the sphincter muscle becomes weak or relaxes when it shouldn't. This allows stomach contents to come up more often or cause irritation.

Reflux is very common in babies and usually goes away on its own. Most babies spit up several times a day during their first 3 months. They usually stop spitting up between the ages of 12 and 14 months.

GERD is less common. Babies may show symptoms, but they decrease with growth, with only a small number of babies affected by 12 months.

Babies are more likely to have reflux or GERD if they:

• Were born too early (premature)
• Have lung problems, such as cystic fibrosis
• Have conditions that affect the nervous system, such as cerebral palsy
• Have a hiatal hernia (when part of the stomach pushes up into the chest)
• Have had surgery on the esophagus

In babies, the main symptom of reflux and GERD is spitting up. GERD may also cause symptoms such as:

• Arching of the back, often during or right after eating
• Coughing
• Gagging or trouble swallowing
• Irritability or crying, especially after eating
• Poor eating or refusing to eat
• Not gaining enough weight or losing weight
• Wheezing or trouble breathing
• Forceful or frequent vomiting

Other conditions can cause similar symptoms. Contact your baby's health care provider if your baby has symptoms, especially if your baby isn't gaining weight.

In most cases, your provider diagnoses reflux by reviewing your baby's symptoms and medical history. Testing is only needed if symptoms don't get better with feeding changes or medicines, or if there are other health concerns.

Several tests can help your provider diagnose GERD. Sometimes more than one test may be ordered to get a diagnosis. Common tests include:

• Upper GI series, which looks at the shape of your baby's upper GI (gastrointestinal) tract. Your baby will drink or eat a chalky-tasting liquid called barium. The barium is mixed in with a bottle or other food. Several x-rays are taken to track the barium as it goes through your baby's esophagus and stomach.
• Esophageal pH or impedance monitoring, which measures the amount of acid or liquid in your baby's esophagus. A thin flexible tube is placed through your baby's nose into the stomach. The end of the tube in the esophagus measures when and how much acid comes up into the esophagus. The other end of the tube attaches to a monitor that records the measurements. Your baby will wear this for 24 hours, most likely in the hospital.
• Upper gastrointestinal (GI) endoscopy and biopsy, which uses an endoscope, a long, flexible tube with a light and camera at the end of it. An endoscope is inserted down your baby's esophagus, stomach, and first part of the small intestine. While looking at the pictures from the endoscope, tissue samples (biopsy) may be taken.

Simple feeding changes may help reduce your baby's reflux:

• Add rice cereal to your baby's bottle of formula or breastmilk. Check with your provider about how much to add. If the mixture is too thick, you can change the nipple size or cut a little "x" in the nipple to make the opening larger.
• Burp your baby after every 1 to 2 ounces of formula. If you breastfeed, burp your baby after nursing from each breast.
• Avoid overfeeding; give your baby the amount of formula or breast milk recommended.
• Hold your baby upright for 30 minutes after feedings.
• If you use formula and your provider thinks that your baby may be sensitive to milk protein, they may suggest switching to a different type of formula. Do not change formulas without talking to your provider.

If feeding changes do not help enough, your provider may recommend medicines to reduce stomach acid. Medicines aren't usually needed, and are only suggested if your baby still has regular GERD symptoms and:

• You have already tried some feeding changes
• Your baby has problems sleeping or feeding
• Your baby does not grow or gain weight properly

Acid-blocking medicines may be given for a short time to see if they help. You shouldn't give your baby any medicines unless your provider tells you to.

If medicines don't help and your baby still has severe symptoms, your provider might talk to you about surgery. Surgery is rarely needed for babies with GERD. It may be considered only if reflux causes serious breathing problems or if your baby isn't gaining enough weight.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Sepsis

What is sepsis?

Sepsis is your body's overactive and extreme response to an infection. Sepsis is a life-threatening medical emergency. Without quick treatment, it can lead to tissue damage, organ failure, and even death.

Sepsis happens when an infection you already have triggers a chain reaction throughout your body. Bacterial infections are the most common cause, but other types of infections can also cause it.

The infections are often in the lungs, stomach, kidneys, or bladder. It's possible for sepsis to begin with a small cut that gets infected or with an infection that develops after surgery. Sometimes, sepsis can occur in people who didn't even know that they had an infection.

Anyone with an infection could get sepsis. But certain people are more likely to develop it:

• Adults 65 or older
• People with chronic (long-lasting) conditions, such as diabetes, lung disease, cancer, and kidney disease
• People with weakened immune systems
• Pregnant women
• Children younger than one

Sepsis can cause one or more of these symptoms:

• Rapid breathing and heart rate
• Shortness of breath
• Confusion or disorientation
• Extreme pain or discomfort
• Fever, shivering, or feeling very cold
• Clammy or sweaty skin

It's important to get medical care right away if you think you might have sepsis or if your infection is not getting better or is getting worse.

Severe cases of sepsis can lead to septic shock, where your blood pressure drops to a dangerous level and multiple organs can fail.

To find out if you have sepsis, your health care provider:

• Will take your medical history, which includes asking about your symptoms
• Will do a physical exam, which includes checking vital signs (your temperature, blood pressure, heart rate, and breathing)
• Will likely order lab tests that check for signs of infection or organ damage
• May order imaging tests such as an x-ray or a CT scan to find the location of the infection

Many of the signs and symptoms of sepsis can also be caused by other medical conditions. This may make sepsis hard to diagnose in its early stages.

It is very important to get treatment right away. Treatment usually includes:

• Antibiotics.
• Maintaining blood flow to organs. This may involve getting oxygen and intravenous (IV) fluids.
• Treating the source of the infection.
• If needed, medicines to increase blood pressure.

In serious cases, you might need kidney dialysis or a breathing tube. Some people need surgery to remove tissue damaged by the infection.

To prevent sepsis, you should try to prevent getting an infection:

• Take good care of any chronic health conditions that you have
• Get recommended vaccines
• Practice good hygiene, such as handwashing
• Keep cuts clean and covered until healed

NIH: National Institute of General Medical SciencesCenters for Disease Control and Prevention

Sexual Problems in Women

There are many problems that can keep a woman from enjoying sex. They include:

• Lack of sexual desire
• Inability to become aroused
• Lack of orgasm, or sexual climax
• Painful intercourse

These problems may have physical or psychological causes. Physical causes may include conditions like diabetes, heart disease, nerve disorders, or hormone problems. Some drugs can also affect desire and function. Psychological causes may include work-related stress and anxiety. They may also include depression or concerns about marriage or relationship problems. For some women, the problem results from past sexual trauma.

Occasional problems with sexual function are common. If problems last more than a few months or cause distress for you or your partner, you should see your health care provider.

Small Intestine Disorders

Your small intestine is the longest part of your digestive system - about twenty feet long! It connects your stomach to your large intestine (or colon) and folds many times to fit inside your abdomen. Your small intestine does most of the digesting of the foods you eat. It has three areas called the duodenum, the ileum, and the jejunum.

Problems with the small intestine can include:

• Bleeding
• Celiac disease
• Crohn's disease
• Infections
• Intestinal cancer
• Intestinal obstruction
• Irritable bowel syndrome
• Ulcers, such as peptic ulcer

Treatment of disorders of the small intestine depends on the cause.