Children with Gastroesophageal Reflux Disease: A Guide to Therapeutic and Pharmacological Treatments
Date of Award
Master of Occupational Therapy (MOT)
Gastroesophageal Reflux -- therapy; Child
Gastroesophageal reflux disease (GERD) is becoming a more common diagnosis with young children and babies (PAGER, 2010). GERD is often misdiagnosed and there is no single test available to determine its presence (Eisen, 2001). The term reflux can be confusing and used to mean different things to different people. Often reflux is linked to colic in babies or may be considered a "normal" part of being a baby. But when a sequalae of symptoms arise in an infant, gastroesophageal reflux becomes a serious issue that needs to be addressed through a variety of interventions and sources (Sondheimer, 2006 ).
In an extensive literature review, the cause of GERD, diagnostic tools, pharmacological interventions, and therapeutic interventions were explored. GERD is thought to be caused by decreased tone in the lower esophageal sphincter (LES) near the stomach which allows contents from the stomach to reflux up into the esophagus and likely out the mouth (Pulsifer-Anderson, 2007). Studies have shown a possible genetic link to families with history of reflux conditions (Orenstein, et ai., 2002), but this gene has not been shown to be present in all people having this disease. A variety of diagnostic tools are being utilized to assist in determining a diagnosis of GERD like barium fluoroscopy, 24-hour pH probe, and endoscopy with biopsy to name the most common procedures. Pharmacology interventions are being widely, and possibly overly, utilized to combat the secondary causes of GERD (Khoshoo, et al., 2007). Generic names of commonly used drugs include Zantac, Prevacid, Prilosec, and Nexium, but with each medicine comes benefits and side effects that must be weighed by the parents and doctors to determine their effectiveness and risk for the child (Hellemeier, 1996). Therapeutic interventions tend to be conservative in nature and include positioning, thickened feedings, and smaller feedings (Orenstein & McGowan, 2008).
The role of the occupational therapist in this setting is to assist the family and child in determining the best course of action and plan that will help their baby. Occupational therapists have special training with feeding (Clark, et al., 2007) as well as utilizing positioning devices and equipment to assist the families in dealing with GERD.
A pamphlet was created to give parents an overview of how to determine their child has GERD, the types of diagnostic tools used to diagnose GERD, pros and cons of the various pharmacological interventions, and how occupational therapists can assist in providing conservative care utilizing positioning and feeding techniques. The pamphlet was designed to be available at doctor offices, public health, early intervention centers, and specialty clinics in an effort to assist parents in navigating the process and dilemma of GERD.
McOmie, Rebecca, "Children with Gastroesophageal Reflux Disease: A Guide to Therapeutic and Pharmacological Treatments" (2011). Occupational Therapy Capstones. 267.