Treatment of reflux problems typically begins with making modifications to a child’s diet and lifestyle routines. Initially, a physician may suggest changes to the infant’s diet, such as smaller or more frequent feedings, or more frequent burpings (after every 1 to 2 ounces of formula, or after feeding from each breast). Parents may be urged to hold their child upright for 30 minutes following feedings. The pediatrician may also recommend thickening a baby’s meal – such as adding a tablespoon of rice cereal to 2 ounces of infant milk – to help reduce reflux.

Certain foods and beverages are known to be triggers of reflux in many children. Types of food and beverages that trigger reflux vary from child to child, but may include:

• Caffeine
• Carbonated beverages
• Citrus foods
• Chocolate
• Fried, greasy and fatty foods
• Garlic
• Onions
• Peppers
• Peppermint
• Spices
• Tomato

If food allergies or intolerances are suspected, changes to a baby’s formula may be suggested. Cow’s milk is also sometimes recommended by a physician. Mothers who are breastfeeding children with food allergies may have to avoid dairy, wheat or egg products while nursing, as well as other foods that may be triggering reflux in their child.

Breastfeeding is typically a good choice for helping a child to avoid reflux. Babies are usually able to digest mother’s milk much more easily than formula, thus reducing the risk of reflux. Breastfeeding mothers may also be urged to quit smoking or drinking caffeinated beverages to prevent these substances from affecting the infant.

Other steps can be taken to reduce a child’s risk of experiencing reflux. Parents are urged to avoid clothing their children in tight pants or diapers that put pressure on the child’s stomach. In some cases, a physician may suggest having a baby sleep on their stomach. Some babies who sleep on their backs are at risk of experiencing reflux, and choking on the stomach contents that are refluxed. However, physicians usually strongly advise against placing infants on their stomachs during sleep, as this can increase the risk of sudden infant death syndrome (SIDS), a condition in which a child under age 1 dies for no obvious reason. Therefore, parents should never place babies to sleep on their stomachs unless recommended by a physician.

Older children may be urged to eat smaller meals and to avoid eating two to three hours before bedtime. It may also help to avoid many of the foods mentioned previously, especially carbonated drinks, chocolate, caffeine and foods that are spicy, high in fat or extremely acidic. Elevating the head of the bed by 30 degrees can also help reduce reflux. Children who are obese or overweight may benefit from losing weight to lessen the pressure on the abdomen.

If these steps fail to relieve symptoms, medications may be prescribed for infants and children. These include the following:

• Antacids. Neutralize stomach acid.
  
  
• Histamine-2 blockers and proton pump inhibitors. Suppress acid production.
  
  
• Promotility drugs. Stimulate the stomach to move contents forward instead of backward. They also may tighten the lower esophageal sphincter (LES).

When dietary changes and medications fail to resolve symptoms, the child may need a surgical procedure to tighten the LES. The standard surgical procedure performed on patients with gastroesophageal reflux disease (GERD) is called Nissen fundoplication, and it is the only anti-reflux surgery performed on children, according to the Pediatric Adolescent Gastroesophageal Reflux Association (PAGER). This surgery involves wrapping the upper part of the stomach around the LES to strengthen it and prevent acid reflux. The procedure can be performed laparoscopically. A few tiny incisions are made in the abdomen and a laparoscope is inserted. A laparoscope is a thin tube with a video camera and it can be fitted with surgical instruments.

In other cases, children who fail to gain weight may require feeding of formula through a tube at night. In some cases, a port may be installed through the child’s abdominal wall to provide a constant drip of formula over a long-term basis.