Gastroesophageal reflux disease (GERD) in children occurs when stomach acid flows back into the esophagus. The severity of this condition varies by age group and may be overlooked, especially in early childhood.

GERD is quite common in children, especially in infants and toddlers. It is seen in about 50% of newborns, but the incidence usually decreases to 5–10% by the age of one. In most cases, GERD resolves spontaneously during childhood. However, some cases require medical treatment. If the symptoms persist beyond 18–24 months, initial management should focus on lifestyle and dietary modifications. If necessary, medication can be introduced. The vast majority of children improve with these measures. Surgery is rarely needed and is reserved for children who either do not respond to medication or have severe symptoms.

Symptoms

Symptoms of GERD in children may include:

• Vomiting or regurgitation of stomach contents

• Chest pain or burning sensation behind the breastbone

• Feeding difficulties

• Poor appetite and inadequate weight gain

• Chronic cough or wheezing

• Sleep disturbances

In severe and untreated cases, more serious complications may occur, such as failure to thrive, frequent respiratory infections, apnea (sudden cessation of breathing), and in the long term, esophageal cancer.

Treatment

Treatment is generally based on the severity of symptoms and the child’s age. However, the first step is always dietary and positional modifications. Measures such as smaller, more frequent meals, avoiding feeding before sleep, keeping the baby upright during and after feeding, and avoiding acidic foods can significantly reduce symptoms.

If symptoms persist, medical treatment is initiated. Common medications include:

• Antacids

• H2-receptor antagonists (e.g., ranitidine)

• Proton pump inhibitors (PPIs) (e.g., omeprazole)

If severe symptoms continue despite medical therapy, surgical intervention is considered. The most commonly performed surgery is fundoplication, in which the upper part of the stomach is wrapped around the lower esophagus to prevent reflux. This procedure is widely performed laparoscopically (minimally invasive) around the world, leading to shorter surgery time, faster recovery, lower risk of complications, and better cosmetic outcomes. Most children are able to resume feeding and normal activities shortly after surgery.

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