Children who experience reflux are likely to have symptoms of chest pain or heartburn if the reflux remains in the esophagus. If stomach contents travel into the mouth, hoarseness and chronic coughing may result. Irritability and sleep problems may also occur. Infants are too young to report these feelings, but other symptoms can alert parents to the possibility of reflux.

For example, infants who experience reflux typically vomit or spit up excessively after a meal because the lower esophageal sphincter opens and stomach contents travel up the esophagus and out of the mouth. Infants may cry a lot, especially after feedings, and may experience episodes in which they twist oddly, as if undergoing a seizure. Bloody stools are also common. None of these symptoms necessarily indicate a medical problem, although steps should be taken to reduce the infant’s reflux.

By the time a child is 1 or 2 years old, reflux usually subsides. Occasional bouts of reflux thereafter are not unusual, but some children may experience more significant symptoms related to reflux.

Parents are urged to consult a physician if their child experiences vomiting with heavy volume or projectile vomiting. Vomit that is green or yellow in color or that has the appearance of blood or coffee grounds also indicates a need for medical attention. Other symptoms requiring medical attention include:

• Breathing problems after vomiting or spitting up
  
  
• Irritability or refusal to feed as a result of pain
  
  
• Painful swallowing
  
  
• Poor growth and weight loss (failure to thrive) as a result of an inability to hold down food

Some children may also inhale stomach acid or food into their lungs. This is known as aspiration, and it can result in asthma, temporary cessation of breathing (apnea), slow heart rate (bradycardia) and in rare cases even death.

Acid contained in reflux that enters the mouth can damage a child’s teeth, resulting in bad breath, cavities and erosion of the tooth enamel. The inner surface of teeth closest to the tongue is most vulnerable to this erosion.

As children grow older, they may experience additional symptoms associated with reflux. These may include chronic coughing, ear pain or infection, hiccups, hoarseness, and high-pitched breathing known as stridor. Older children with reflux may also experience the following symptoms:

• Bad breath
  
  
• Behavioral issues (e.g., chronic pain causing a low tolerance for frustration)
  
  
• Coughing
  
  
• Excessive burping
  
  
• Pickiness when eating
  
  
• Restless sleep