— Stacy, North Carolina First and most importantly, you need to make sure that your son’s diagnosis is correct. Did he have an upper endoscopy or radiology study that actually showed GERD? Occasionally doctors will prescribe medications, such as Prilosec or Pepcid, for symptoms that are consistent with GERD without using diagnostic testing. At this point, since your son is not responding to the usual GERD medications, make sure he sees a gastroenterologist and undergoes tests to confirm that GERD is actually the problem. Prilosec and Pepcid block acid by very different mechanisms — Prilosec blocks the acid pump, whereas Pepcid only blocks one of the receptors on acid-producing cells and is less effective at blocking acid secretion. If your son indeed has GERD, increasing his dose of Prilosec to twice a day may be more effective than the Prilosec/Pepcid combination. Prilosec should be taken on an empty stomach at least 30 minutes before a meal or a snack for its best effect. Talk to his doctor about trying this approach. Q2. I have a 17-month-old baby girl who has been throwing up within 15 minutes of falling asleep. During the day when she is up and about, she retains her milk. She has always taken a bottle of milk to bed during nap time, but now she cannot retain that milk. I have tried not to give her milk when she is lying down, but she gets very cranky without her bottle. I am forced to give her the bottle in the middle of the night — as she is up and crying with hunger — only to have her throw up yet again. Do you have any advice about why this might be happening? Jenny the first thing I would consider as a possible cause for the vomiting in your daughter is reflux. This is very common in children and is often worsened by lying down. I would advise you to try to prevent your daughter from lying down for at least 20 minutes after she feeds. This means she will have to give up her naptime and nighttime feedings. Many a parent stresses over how to drop these feedings. You can be comforted in knowing that at 17 months your daughter does not nutritionally need a middle-of-the-night feeding, it is just something she has gotten used to and likes. I recommend that you drop one feeding at a time and would start with the middle of the night bottle. This will be a difficult transition for her, but I think she is at a good age to do it. If you find that her throwing up is worsening, is a green color, starts occurring when she is not lying down, or is associated with pain, these would all be reasons to take her to her pediatrician and have this evaluated further. When in doubt, check in with your pediatrician! Q3. My daughter is 7 and has symptoms similar to GERD. She will often say it feels like she is going to throw up and she spits out saliva; she has complained of upset stomach and says there’s something in her throat before spitting out some saliva that appears clear. The dentist did not notice acidic changes on her teeth. — Monica, Washington Your daughter may well have gastroesophageal reflux disease (GERD) since this condition occurs in children as well as in adults. Some of the symptoms described by your daughter do fit GERD, including nausea, regurgitation of clear fluid, a feeling that something is present in the throat, and having an upset stomach. However, not everyone with these symptoms is diagnosed with GERD; many have dyspepsia (a vague discomfort in the upper abdomen or chest that may be described as gas, a feeling of fullness, gnawing, or burning) or other functional symptoms that are not related to GERD. GERD is usually the result of a relaxed lower esophageal sphincter that allows stomach contents, including acid, to regurgitate into the esophagus and sometimes as far as the mouth. Treatment usually includes blocking acid production and lifestyle and nutritional measures that reduce the amount of reflux. Your daughter should be seen by a gastroenterologist, who can make a proper diagnosis and start appropriate treatment, either for GERD, if it turns out to be that, or for another condition. Learn more in the Everyday Health GERD Center.
