Caring for People With Gastroesophageal Reflux Disease (GERD)

Gastroesophageal reflux disease (GERD) is becoming an increasing problem for people of all ages in the United States. This is probably due in part to an increase in the consumption of fast food, which tends to be greasy and fatty, as well as the escalating rate of obesity. If you suspect your child, parent, partner, or another loved one is suffering from acid reflux, it's important that he or she sees a doctor who will be able to determine if a diagnosis of GERD is appropriate and exclude all other disorders with similar symptoms.

The severity of your loved one's GERD symptoms will determine the best treatment options. In the meantime, here are ways you can help lessen the severity of his or her heartburn symptoms at home.

Food Choices

The lower esophageal sphincter (LES), the valve between the esophagus and stomach, normally closes tightly to keep food and stomach acid where it belongs. If it relaxes when it shouldn't, food and stomach acid come back up into the esophagus and cause heartburn.

Heartburn is often triggered by certain foods. Help your loved one become familiar with these triggers and try to keep trigger foods out of the house so he won't be tempted and end up in pain.

Foods that can relax the LES include:

  • Fried (greasy) foods
  • High-fat meats
  • Butter and margarine
  • Mayonnaise
  • Creamy sauces
  • Salad dressings
  • Whole-milk dairy products
  • Chocolate
  • Peppermint
  • Caffeinated beverages (e.g., soft drinks, coffee, tea, cocoa)

Heartburn may also occur when the stomach produces too much acid, and this backs up into the esophagus.

Foods that may stimulate acid production and increase heartburn include:

  • Caffeinated beverages
  • Carbonated beverages
  • Alcohol
  • Spicy foods
  • Black pepper
  • Citrus fruit and juices (e.g., orange, grapefruit)
  • Tomato juice

Eating Out

When you eat out, inquire as to how different dishes are prepared, if your loved one doesn't.

You can ask that meat is grilled rather than fried, for example. Many dishes include high-fat gravies and sauces that you can ask to have switched to a low-fat substitute or served on the side. While adults will undoubtedly want to make their own choices when it comes to food, starting the conversation may help lead the way to better choices.

At School

To help your child avoid these foods while at school, you can pack school lunches less likely to cause heartburn on days when trigger foods are being served. Typical school lunches are often contain a lot of acid-stimulating foods. Knowing which foods are safe for heartburn sufferers will help too.

Mealtime

Encourage your loved one to cut down the size of her meals, as they expand the stomach and can increase upward pressure against the lower esophageal sphincter (LES), which causes heartburn. Because kids and teenagers are growing, they may feel hungry when they scale back their portion sizes at first. If this is the case, remind your child that she can eat less more often, but that she shouldn't eat until she's full at any one meal. This transition to "snacking" may appeal to some kids.

Using smaller dishes at home, preparing less food, and serving meals from the stove (rather than the table, where it's easy to reach for seconds) may be helpful strategies.

Late night snacking may be your loved one's bedtime ritual, but if she suffers from GERD, it can make for a painful, uncomfortable night's sleep. Try to dissuade her from eating during the two- to three-hour window before she goes to bed, perhaps by avoiding snacking yourself.

Gravity helps keep the stomach juices from backing up into the esophagus and assists the flow of food and digestive juices from the stomach to the intestines. So, while after dinner snacking isn't advised, staying up for a while after the meal can help give the body time to take advantage of gravity's forces while food is being digested.

Bedtime

Nighttime heartburn can be the most dangerous. If frequent nighttime heartburn occurs, the risk of complications increases. There are several reasons for this. For example, refluxed acid tends to remain in the esophagus for longer periods, allowing it to cause more damage to the esophagus. There are, however, a few ways to prevent nighttime heartburn.

Lying down flat presses the stomach's contents against the lower esophageal sphincter (LES). With the head higher than the stomach, gravity helps reduce this pressure. Ask your loved one's doctor how high to elevate the head of the bed. Elevating the entire head of the bed by placing bricks or wooden blocks under the feet on that side, so that the bed is at a slight slant, works well. Your doctor may also suggest using an acid reflux bed or a wedge pillow to elevate your loved one's head while sleeping.

Clothing Choices

Clothing that's tight around the abdomen squeezes the stomach, forcing food up against the LES, causing food to shoot back up into the esophagus. It's, of course, easier to influence what clothing a child wears compared to a teen, who likely has his or her own style. However, talking to your teen about how dressing for comfort can ease her heartburn may lead him or her to make such choices. Clothing that can cause problems includes tight-fitting belts, tight-waisted jeans, and slenderizing garments.

Symptom Tracking

Buy your loved one a journal and, if he's able and willing, have him record when he experiences heartburn symptoms, what foods were consumed, and/or what activity he was doing before the heartburn occurred. The severity of each heartburn episode and what gave him relief should also be noted. He can rank his discomfort on a scale of 1 to 10 with 10 being the most discomfort he can imagine and 1 being pain that is barely there.

He can bring this information to his doctor, who can then help him make modifications to his diet, activity, or medications, if needed.

This is a helpful strategy for parents of teens who are resistant to their suggestions; recommendations from a doctor may be better received.

Exercise

If your loved one is overweight or obese, even losing 5 or 10 pounds can help alleviate heartburn symptoms and exercise, in general, is beneficial for a host of reasons. Encourage her to go on walks, ride her bike, or jump on the treadmill while she's watching TV. Try fun family activities like bowling, hiking, gardening, or swimming. Getting active with your loved one may help her feel more motivated.

Medications

Antacids like Tums, Rolaids, and Mylanta neutralize stomach acid. It's helpful to keep them handy, especially if your loved one often forgets them. However, if he or she needs to use antacids for more than a week or so, or if an antacid doesn't quickly resolve symptoms, a visit to the doctor is recommended. Using an antacid for more than one to two weeks should only be done with the guidance of a physician.

If your loved one has made dietary and lifestyle changes that reduce heartburn without success, it may be time to use one of the stronger medications. Beyond antacids, there are two primary categories of heartburn medications:

  • Acid blockers (H2 blockers), such as Tagamet (cimetidine), Pepcid (famotidine), Zantac (ranitidine), and Axid (nizatidine)
  • Acid suppressors (proton pump inhibitors, PPIs), such as Prilosec (omeprazole), Prevacid (lansoprazole), Nexium (esomeprazole), Aciphex (rabeprazole), and Protonix (pantoprazole)

However, long-term use of these drugs has been associated with kidney disease, heart attack, and bone fractures. Potential side effects should be discussed with a physician. Long-term acid reflux can also result in complications, so your loved one's doctor can help you weigh the risks and benefits of treatment.

If your loved one often forgets to take his or her medication (or you, as a parent, forget to give it to your child), you may find medication reminder smartphone apps helpful.

Support

The best treatment for acid reflux is prevention, and making changes to your loved one's diet, sleeping position, and activity is the best way to begin. These changes, however, can sometimes be hard to make. Do what you can to encourage and set your loved one up for success, and try to have patience as they find their way (or you, as a parent of a child with GERD, do the same).

Involving your loved one's doctor can be helpful, not only in learning more about how to control his symptoms and finding a medication that helps, but because it involves someone else who can support and back you in the suggestions you have made. If you're a parent, remember that eventually most teens outgrow moments of defiance and take a greater role in working to reduce the symptoms they must cope with.

Sources:

Baird DC, Harker DJ, Karmes AS. Diagnosis and Treatment of Gastroesophageal Reflux in Infants and Children. American Family Physician. October 15, 2015;92(8):705-14.

Lightdale JR, Gremse DA, Section on Gastroenterology, Hepatology, and Nutrition. Gastroesophageal Reflux: Management Guidance for the Pediatrician. Pediatrics. May 2013;131(5):e1684-95. doi:10.1542/peds.2013-0421.