Gastro-esophageal reflux disease (GERD) can related to the relaxation or incompetence of the lower esophageal sphincter (McCance & Huether, 2010, p. 1523). It was also described by Brunner, Suddarth, & Smeltzer (2008, p. 1165), as the back flow of gastric or duodenal content into the esophagus. It can be a normal physiological process that happens in a healthy child for several times in a day, it becomes a concern when it results to worrisome symptoms or complications.
Inappropriate esophageal sphincter relaxation that occurs in GERD can be as a result of delay in the maturation of the lower esophageal sphincter, and alteration in neurotransmitter or hormonal response mechanism (McCance & Huether, 2010, p. 1523). Lower esophageal sphincter integrity in children are maintained by mucosal gathering within the sphincter, esophageal junction location in a high pressure zone within the abdomen and angle at which the esophagus is inserted into the stomach. If any of the pressure maintaining factors that preserves the integrity of the lower esophageal sphincter discussed above is altered, the reflux persists. Acidic gastric content provokes the sphincter leading to deterioration of the esophageal epithelium and stimulation of the vomiting reflex (McCance & Huether, 2010, p. 1523).
As a result of lack of well-developed neuromuscular control, hormones and increased intra-abdominal pressure, children are unable to control gastric acid reflux to the esophagus. Young infants have increased intra-abdominal pressure because they can’t stand upright, they regurgitate when they cough, cry, or strain. A study by Burns et al (2010, p. 748), elaborates that 73% of healthy young infants regurgitates during ...
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... be educated to keep their child in upright position during feeding and for about 30 minutes after feeding, elevate the head of the crib mattress or bed 30 degrees and not to use pillow, to keep infants in prone position postprandially when awake but not asleep, not to thicken formulas with rice cereal, to void smoking in the house hold, to give a milk free and soy free diet, avoid too large meal at a time and give small frequent meals instead ("UpToDate," 2013, p. 1). Education for children and their parents should include elevating the head of bed, to maintain body weight according to guideline or lose weight if indicated, parent and adolescent who smoke should stop smoking, avoid eating within 1-3 hours of going to bed and to avoid substances that can cause lower esophageal relaxation including caffeine, chocolate, peppermint, garlic, citrus tomatoes and alcohol.
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