Positioning
Positioning can alleviate reflux. For feeding, the child should be in an upright position, and also for some time after feeding to allow for digestion. In the crib or bed, the head should be elevated. Sitting in an infant seat can even worsen the reflux because the weight of the body is on the belly.
How is presence of GERD determined?
There are many symptoms that a doctor might consider as indications that the child is suffering from GERD. Irritation, screaming, and obvious discomfort can be signs of reflux . The gastric acid from the stomach contents burns the esophagus and throat. It can also cause earaches. Hyperextension of the head and neck can be an indication. Hoarseness can also be a sign due to acid in the larynx (acid laryngitis). Asthma, wheezing, and coughing (when possible) can indicate reflux as well. Failure to thrive could be caused by reflux. Many brain injured children with reflux develop aspiration pneumonia. Aspiration pneumonia causes lung damage, so the earlier you catch the reflux problem, the better.
Usually a series of tests are done to determine whether reflux is occurring before a decision is made to do the surgery. In some cases, all of these tests are done, in other cases only one or two. An UpperGI series checks for hiatal hernia, spontaneous reflux and anomalies in the organs. An UpperGI endoscopy assesses the degree of esophageal injury from reflux. In endoscopy a thin tube in inserted down the throat to look at any internal damage that may have occurred. A 24 hour Ph probe can also be used to test amount and occurrence of reflux. In addition, there is a less invasive test where the doctor adds dye to the formula to see if any of the formula comes back up spontaneously or through suctioning. This is not a formal test as it can't really diagnose silent reflux confidently.
