Natural Treatments For Gastroesophageal Reflux Disease (GERD) In Kids
It is well known that the pharmaceutical treatment for gastroesophageal reflux disease (GERD) carries significant short and long term risks for infants and children. Luckily, there are safe and effective natural treatments for GERD in infants and children. If natural treatment fails and acid suppression therapy is necessary, bolstering the immune system and supporting the body with additional nutrients may help counteract the negative consequences of acid suppression.
What Is Gastroesophageal Reflux Disease (GERD)?
Gastroesophageal Reflux Disease is a condition in which the contents of the stomach backflow into the esophagus. This can cause symptoms like burning pain (heartburn) after eating, nausea, coughing, hoarseness in the morning, trouble swallowing, bad breath, the sensation of choking or tightness in the throat, or the sensation of food stuck in the back of the throat.
Gastrointestinal reflux happens to most people at some point in their lives. GER is very common in infants, sometimes happens transiently after gastrointestinal infection, and is a side effect of some medications (like muscle relaxants, certain painkillers, and blood pressure medications). Reflux is also common during pregnancy, in people who are obese, and in people who smoke or who are exposed to second hand cigarette smoke. Stress and anxiety are also linked to reflux. GERD is more common in adults than in children.
Transient or occasional reflux isn’t something to worry about. However, frequent reflux that causes interference with eating or enjoying daily life needs to be treated. Left untreated GERD can significantly decrease quality of life, interfere with growth and development, and in the longer term it can lead to serious injury of the esophagus.
What Is The Difference Between Normal Reflux And GERD?
In infants, reflux is common, normal, and harmless. Occasional heartburn also happens in childhood and adolescence. However, if reflux is frequent and severe it needs to be addressed.
In infants, a diagnosis of GERD (gastroesophageal reflux disease) rather than GER (gastroesophageal reflux) may be considered if airway symptoms are present or if the infant is refusing to eat and/or having difficulty gaining weight. In infants, acid suppressing drugs aren’t very helpful and should be a last resort if lifestyle interventions haven’t worked. FPIES and other food allergies should also be considered in many cases.
Older children and adolescents with GERD may complain of pain or burning in their upper chest, especially after eating. This pain often gets worse lying down. They may burp frequently, have frequent nausea, have difficulty swallowing, taste acid in the back of their throat, or have the feeling of something stuck in the back of their throat.
Natural Treatment For Pediatric GERD
When I treat pediatric GERD in my office, I focus on diet, lifestyle modifications, natural medicine, and referral for manual therapies if needed. Acid suppressing medications are a last resort.
Diet Modifications For Pediatric GERD
There are several dietary modifications that I consider when addressing GERD for my pediatric patients.
- Eat smaller meals more frequently.
- Drink less with meals and more outside of meal time.
- Avoid peppermint tea after meals because it can impair the gastroesophageal sphincter. Try fennel or licorice tea instead.
- Check for food allergies, especially gluten, dairy, egg, and soy.
- Try an elimination diet to determine if any of the foods that irritate the gastroesophageal sphincter are causing trouble, including: tomatoes, caffeine, acidic fruits and vegetables, spicy food, sweets, high fat foods, chocolate, carbonated beverages.
- If breastfeeding, try an elimination diet for mom that removes at least gluten, dairy, soy, and eggs.
- If formula feeding, try switching to an extensively hydrolysed protein formula or elemental formula.
- Avoid big meals before vigorous physical activity.
- Avoid large meals immediately before bed (at least 2-3 hours before bed is preferred).
Lifestyle Modifications For Pediatric GERD
Often lifestyle changes can make a big difference for the symptoms of GERD.
- Avoid exposure to secondhand cigarette smoke.
- Sit upright after meals.
- Avoid tight clothing around the waist.
- Eat slowly and mindfully at the table rather than in front of screens.
- Decrease stress around mealtimes and stress in general.
- Elevate the head during sleep for older children and adolescents.
- If ibuprofen or NSAID overuse is contributing to GERD, consider other pain management medications and techniques.
Natural Medicines For Pediatric GERD
- Ginger is a frequently used herbal medicine for GERD and it can be very helpful, especially if nausea is a prominent symptom.
- Fennel, licorice, marshmallow, catnip teas or glycerites are soothing options to help manage pain and inflammation associated with GERD.
- Bitter herbs like dandelion and yellow dock are sometimes used to support healthy digestion. Bitter herbs should be used with supervision from an experienced practitioner because in some cases they can aggravate GERD.
- Melatonin is linked to gut motility. If GERD occurs alongside insomnia, I sometimes consider melatonin as part of the treatment plan.
- Probiotics can be helpful for GERD. I often add probiotics to treatment plans if GERD started after a gastrointestinal infection or after antibiotic use.
- While treating GERD it is important to protect against and correct nutrient deficiencies. A high quality multivitamin is often enough, but targeted supplementation with zinc, iron, calcium, magnesium or vitamin B12 may be needed.
Consider Manual Therapies For Pediatric GERD
In my practice, I’ve seen many digestive concerns in children and babies improve or resolve with manual treatment. I find that the practitioner is more important than the modality. It is worth asking around your community to find a massage therapist, chiropractor, osteopath, acupuncturist, or craniosacral therapist who treats children.
When To Consider An Acid Suppressing Medication
Sometimes despite best efforts, kids don’t respond to natural medicines and lifestyle modifications. In these cases, the benefits of acid suppression therapy outweigh the risks.
Histamine blockers (H2RA) like pepcid (aka. famotidine) are usually tried first for a two week trial. If they don’t provide any improvement, acid is unlikely to be at the root cause of the symptoms. If they provide only partial improvement or if they cause unpleasant side effects, a two week trial or a proton pump inhibitor (PPI) like Losec (aka. omeprazole) is usually done next. If one of these medications is effective, it is given for 4-6 weeks to allow healing of the stomach and esophagus to happen and then weaning is attempted . For more information on healing the gut, see How To Heal The Gut For Kids – Dr. Green Mom.
An estimated 80% of children who require long term treatment of GERD have an underlying condition which may affect the nervous system, esophagus, digestive tract, lungs, or other systems. In these cases, acid suppressing medications can provide relief and protection while the underlying cause is addressed.
If the underlying cause of GERD can’t be addressed and chronic acid suppressing medication is required, it’s important to remember that this comes with some risks. These risks are likely related to reduced absorption of nutrients and the absence of the immune protection that stomach acid provides. To buffer against these risks, I often recommend an immune fortifying protocol along with nutrient supplementation. A well rounded multivitamin may be all that is needed, but additional supplementation with zinc, iron, calcium, magnesium, or vitamin B12 could be considered on a case by case basis.
Note: Long term use of acid suppressing drugs causes more acid producing cells to grow in the stomach. This is harmless and reverses itself after the drugs are stopped. But it is good to keep in mind because if acid suppressing drugs are stopped abruptly, then rebound reflux symptoms will occur and it will falsely appear that continued drug use is necessary. It is important to wean off acid suppressing drugs slowly.
Gastroesophageal reflux disease (GERD) is a condition where the contents of the stomach backflow into the esophagus and cause symptoms. GERD can often be managed with diet, lifestyle, and natural medicine. Sometimes people don’t respond to natural medicine and acid suppressing drugs are required. Long term acid suppression therapy comes with risks of reduced nutrient absorption and reduced immune function which can be addressed with natural medicine.
Hassall E. (2012). Over-prescription of acid-suppressing medications in infants: how it came about, why it’s wrong, and what to do about it. The Journal of pediatrics, 160(2), 193–198. https://doi.org/10.1016/j.jpeds.2011.08.067
Naliboff, B. D., Mayer, M., Fass, R., Fitzgerald, L. Z., Chang, L., Bolus, R., & Mayer, E. A. (2004). The effect of life stress on symptoms of heartburn. Psychosomatic medicine, 66(3), 426–434. https://doi.org/10.1097/01.psy.0000124756.37520.84
AAP Releases Guideline for the Management of Gastroesophageal Reflux in Children
GERD in Children: Symptoms, Causes and Treatments
Schulz, R. M., Ahuja, N. K., & Slavin, J. L. (2022). Effectiveness of Nutritional Ingredients on Upper Gastrointestinal Conditions and Symptoms: A Narrative Review. Nutrients, 14(3), 672. https://doi.org/10.3390/nu14030672
de Oliveira Torres, J. D., & de Souza Pereira, R. (2010). Which is the best choice for gastroesophageal disorders: Melatonin or proton pump inhibitors?. World journal of gastrointestinal pharmacology and therapeutics, 1(5), 102–106. https://doi.org/10.4292/wjgpt.v1.i5.102
Cheng, J., & Ouwehand, A. C. (2020). Gastroesophageal Reflux Disease and Probiotics: A Systematic Review. Nutrients, 12(1), 132. https://doi.org/10.3390/nu12010132
Gauer, R. L., Burket, J., & Horowitz, E. (2014). Common questions about outpatient care of premature infants. American family physician, 90(4), 244–251.
Wang Y, Wintzell V, Ludvigsson JF, Svanström H, Pasternak B. Association Between Proton Pump Inhibitor Use and Risk of Asthma in Children. JAMA Pediatr. 2021;175(4):394–403. doi:10.1001/jamapediatrics.2020.5710
Jarosz, M., & Taraszewska, A. (2014). Risk factors for gastroesophageal reflux disease: the role of diet. Przeglad gastroenterologiczny, 9(5), 297–301. https://doi.org/10.5114/pg.2014.46166
Corvaglia, L., Mariani, E., Aceti, A., Galletti, S., & Faldella, G. (2013). Extensively hydrolyzed protein formula reduces acid gastro-esophageal reflux in symptomatic preterm infants. Early human development, 89(7), 453–455. https://doi.org/10.1016/j.earlhumdev.2013.04.003
Untersmayr, E., Schöll, I., Swoboda, I., Beil, W. J., Förster-Waldl, E., Walter, F., Riemer, A., Kraml, G., Kinaciyan, T., Spitzauer, S., Boltz-Nitulescu, G., Scheiner, O., & Jensen-Jarolim, E. (2003). Antacid medication inhibits digestion of dietary proteins and causes food allergy: a fish allergy model in BALB/c mice. The Journal of allergy and clinical immunology, 112(3), 616–623. https://doi.org/10.1016/s0091-6749(03)01719-6
Cohen, S., Bueno de Mesquita, M., & Mimouni, F. B. (2015). Adverse effects reported in the use of gastroesophageal reflux disease treatments in children: a 10 years literature review. British journal of clinical pharmacology, 80(2), 200–208. https://doi.org/10.1111/bcp.12619
Untersmayr, E., & Jensen-Jarolim, E. (2008). The role of protein digestibility and antacids on food allergy outcomes. The Journal of allergy and clinical immunology, 121(6), 1301–1310. https://doi.org/10.1016/j.jaci.2008.04.025
Trikha, A., Baillargeon, J. G., Kuo, Y. F., Tan, A., Pierson, K., Sharma, G., Wilkinson, G., & Bonds, R. S. (2013). Development of food allergies in patients with gastroesophageal reflux disease treated with gastric acid suppressive medications. Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology, 24(6), 582–588. https://doi.org/10.1111/pai.12103
Laura Malchodi, Kari Wagner, Apryl Susi, Gregory Gorman, Elizabeth Hisle-Gorman; Early Acid Suppression Therapy Exposure and Fracture in Young Children. Pediatrics July 2019; 144 (1): e20182625. 10.1542/peds.2018-2625
Farrell, C. P., Morgan, M., Rudolph, D. S., Hwang, A., Albert, N. E., Valenzano, M. C., Wang, X., Mercogliano, G., & Mullin, J. M. (2011). Proton Pump Inhibitors Interfere With Zinc Absorption and Zinc Body Stores. Gastroenterology research, 4(6), 243–251. https://doi.org/10.4021/gr379w
Ito, T., & Jensen, R. T. (2010). Association of long-term proton pump inhibitor therapy with bone fractures and effects on absorption of calcium, vitamin B12, iron, and magnesium. Current gastroenterology reports, 12(6), 448–457. https://doi.org/10.1007/s11894-010-0141-0
Helgadottir, H., & Bjornsson, E. S. (2019). Problems Associated with Deprescribing of Proton Pump Inhibitors. International journal of molecular sciences, 20(21), 5469. https://doi.org/10.3390/ijms20215469
Boghossian, T. A., Rashid, F. J., Thompson, W., Welch, V., Moayyedi, P., Rojas-Fernandez, C., Pottie, K., & Farrell, B. (2017). Deprescribing versus continuation of chronic proton pump inhibitor use in adults. The Cochrane database of systematic reviews, 3(3), CD011969. https://doi.org/10.1002/14651858.CD011969.pub2
Qvigstad, G., & Waldum, H. (2004). Rebound hypersecretion after inhibition of gastric acid secretion. Basic & clinical pharmacology & toxicology, 94(5), 202–208. https://doi.org/10.1111/j.1742-7843.2004.pto940502.x