Pathophysiology
& Prognosis
& Prognosis
This muscle’s immaturity in infants is the main reason why reflux occurs during early development
Lower esophageal sphincter (LES)
This is the most common symptom associated with GER; describes when an infant spits up stomach contents after feeding
Regurgitation or vomitting
This class of drugs, which includes omeprazole, is the pharmacological treatment of choice for pediatric GER
PPIs (Proton Pump Inhibitors)
What diagnostic finding confirms GERD when viewed through an endoscopy
Inflammation
How should infants with GER be positioned to reduce reflux
Upright or left lateral (supine positioning increases reflux)
Why do infants experience more frequent reflux compared to older children
Immature LES
Chronic irritation of the esophagus can cause difficulty swallowing, known as this symptom (medical term)
Dysphagia
What intervention, usually starting at 6 months or at the start of teething, can be introduced to decrease reflux
Introducing solid foods
A baby with frequent coughing and poor weight gain is suspected of reflux. The nurse wants to confirm acid exposure in the esophagus over time. What test should be ordered
Esophageal pH test
This type of feeding schedule helps keep the stomach from getting too full, causing regurgitation
Small, frequent feedings?
What percentage of infants with GER improve by 9–12 months of age
95%
What symptom(s) might a caregiver notice that suggests discomfort from reflux after feeding
Irritability
Crying
Difficulty consoling
Antacids can be used for children, but they are not recommended for this patient population
Infants
When does gastroesophageal reflux become gastroesophageal reflux disease (GERD)
When it causes poor growth, respiratory problems, or significant feeding difficulties
Suggest avoiding this type of food in older children with GER (Name at least 2)
Spicy foods
Fatty foods
Peppermint
Chocolate
Fried foods
Why might some infants develop aspiration pneumonia from GER
Refluxed stomach contents enter the airway instead of the esophagus
What respiratory sound may suggest aspiration/esophageal inflammation due to GER
Wheezing or stridor
What developmental milestone helps to reduce reflux symptoms at approximately the age of 12 months
Standing upright
This test involves a child drinking a special liquid so X-rays can show how food moves through the upper digestive tract
Barium swallow
When should GER medication be given for best effect
Before meals
What complications can occur after surgical treatment for GER?
Infection
Dysphagia
Gas-bloat/Dumping Syndrome
Recurrence
Adolescents with chronic GER may develop this condition due to blood loss from esophageal irritation
Anemia
These surgeries may be recommended for severe GER(D) (Name 1/3)
Laparoscopic Anti-Reflux Surgery (LARS)
Nissen Fundoplication
Esophagogastric Disconnection aka. Bianchi procedure
Endoscopic evidence of esophageal inflammation from prolonged, untreated acid exposure in a child indicates this diagnosis
Progression to GERD
What feeding modification can help reduce regurgitation in bottle-fed infants with GER
Thickening formula with rice cereal or a commercial thickening agent