Complications Caused By Infant Reflux and GERD

Within the acceptable limits of weight gain, there are those that fall in the high end and those that fall in the low end.

Sometimes; however, babies will not gain weight at an acceptable or safe rate and fall below even the low end of the scale.  These babies are labeled as failure to thrive.

Failure to thrive is a general term, and can have many different causes.  Causes of failure to thrive tend to be classified as organic (an underlying health issue), or inorganic (external reasons, for example the caregiver).  Failure to thrive caused by GERD is classed as organic and is in no way the fault of the caregiver.

GERD can cause failure to thrive a few ways.  Even with the most enthusiastic eaters, frequent or constant vomiting of entire feeds will make weight gain, or even maintaining current weight, difficult or impossible.  Even if vomiting isn't present, some babies will begin to associate food with pain and unpleasantness from their reflux and they will begin to develop aversions to eating.  They will actually refuse their meals making it difficult to obtain weight gains.  Although there are some things that can help with feeding a stubborn eater, these tricks will work with some children, others actually require tube feeding to gain weight and survive.  What's the old saying about leading a horse to water...? Read More About Failure To Thrive »

Sometimes journaling your child's food intake can help you keep better track of their caloric intake and can help with failure to thrive.  Print our free journal pages »

food and oral aversions

As touched on above, associations made by the baby between food and pain can cause some to become difficult to feed, or even stop eating altogether.  As a parent, this can be one of the more frustrating complications since some children are so fearful of food nothing short of tube feeding can provide the nourishment required.  The draw backs of short term tube feeding— those inserted through the nose—can unfortunately be food and oral aversions.  Inserting feeding tubes can reinforce baby's bad feelings about anything going into their mouth, as they can have a difficult time separating the two areas of the face.

gagging and choking

Babies and children with GERD seem to have a stronger gag reflex than other children and may gag and choke on their food frequently.  They may also gag and choke throughout the day for no apparent reason, this is likely from refluxed material coming part of the way up, perhaps into the throat enough to cause a gag, or into the airways enough to temporarily block airflow.

apnea

Apnea refers to an period of more than ten to twenty seconds of interrupted breathing.  Children with GERD are susceptible to apnea episodes because refluxed material can block the airways, preventing air flow.

aspiration and aspiration pneumonia

Aspiration is when food or refluxed material is allowed to enter the lungs.  The damage done to the lungs (if any) is determined by the characteristics and amount of aspirated material.  The more acidic it is, the more severe the injury to the lungs.  Aspiration itself won't cause pneumonia, if the lungs become infected from the aspirated material, pneumonia can occur.

asthma

It's suggested that more than 75% of people (of all ages) with asthma also have reflux or GERD and those who have asthma are twice as likely to have GERD as those who don't.  Read more about the asthma / reflux connection>.

chronic cough, hoarseness or laryngitis

Just as acid refluxed from the stomach can damage the esophagus and lungs, it can damage the throat and vocal cords.  In some cases this can be the only symptom of GERD, making it more difficult to diagnose.

dysphagia and strictures

Dysphagia means difficulty swallowing.  The main cause of dysphagia from reflux is severe scarring in the esophagus (strictures) from constant acid exposure.  The scar tissue is thicker than the normal lining of the esophagus causing strictures that can basically clog the esophagus and prevent food and even liquids from passing through.  Although rarely does it get this severe in infants it is possible if left untreated.

esophagitis

Inflammation of the esophagus caused by frequent contact with stomach acid.

anemia

Anemia is caused by blood loss and is defined as a drop in hemoglobin count (distributes oxygen to the body's cells and carries carbon dioxide back to the lungs).  Reflux can cause anemia by eating away the esophagus until it begins to bleed.  Like the strictures, it would be rare for it get this extreme in infants, but again, if left untreated, it's possible.

eroded dental enamel

Stomach acid entering the mouth can erode teeth, just as it does the esophagus, throat, vocal cords, etc.

barrett's esophagus

This occurs when cells in the esophagus change in an attempt at protecting themselves against constant acid exposure.  The stomach is protected from the acid it produces by special cells called columnar epithelium cells.  The esophagus has more delicate cells called squamous epithelium which are not designed to protect against acid.  When it becomes chronically burned and damaged from acid exposure, these delicate squamous epithelium cells attempt to protect themselves against further damage by replacing the squamous epithelium cells with a special type of cell similar to the columnar epithelium cells found in the stomach.  It is unknown why, but these changes are pre-cancerous.  This is not likely to occur in infants, it takes long term acid exposure for this to occur.

cancer

Years of untreated GERD can eventually result in esophageal cancer.  It is said that the survival rate is low because symptoms usually only appear after it has progressed to other areas of the body.

Reviewed By Dave Olson, MD
Fellow, American Academy of Pediatrics
Graduate University of Michigan School of Medicine