Diagnosis of GER & GERD in Infants

How do doctors diagnose GER in infants?

In most cases, a doctor diagnoses gastroesophageal reflux (GER) by reviewing an infant’s symptoms and medical history. If symptoms of GER do not improve with feeding changes and anti-reflux medicines, he or she may need testing.

How do doctors diagnose GERD in infants?

The doctor may recommend testing for gastroesophageal reflux disease (GERD) if

  • an infant’s symptoms don’t improve
  • he or she is not gaining weight
  • he or she is having lung problems

The doctor may refer the infant to a pediatric gastroenterologist to diagnose and treat GERD.

What tests do doctors use to diagnose GERD in infants?

Several tests can help a doctor diagnose GERD. A doctor may order more than one test to make a diagnosis.

Upper gastro intestinal (GI) endoscopy and biopsy

In an upper GI endoscopy, a gastroenterologist, surgeon, or other trained health care professional uses an endoscope to see inside an infant’s upper GI tract. This procedure takes place at a hospital or an outpatient center. A health care professional will use an upper GI endoscopy especially if an infant has growth or breathing problems.

An intravenous (IV) needle is placed into one of the veins in the infant’s arms, hands, or feet to give him or her medicines to keep him or her relaxed during the endoscopy procedure. The infant will receive extra oxygen throughout the procedure. The health care professional carefully feeds the endoscope down the infant’s esophagus and into the stomach and duodenum. A small camera mounted on the endoscope sends a video image to a monitor, allowing close examination of the lining of the upper GI tract. The endoscope pumps air into the infant’s GI tract, making them easier to see.

The doctor may perform a biopsy with the endoscope by taking a small piece of tissue from the lining of the infant’s esophagus. He or she won’t feel the biopsy. A pathologist examines the tissue in a lab.

In most cases, the procedure only diagnoses GERD if the infant has moderate to severe symptoms

Upper GI series

An upper GI series looks at the shape of an infant’s upper GI tract.

An x-ray technician performs this procedure at a hospital or an outpatient center. A radiologist reads and reports on the x-ray images. The infant doesn’t need anesthesia. If possible, you shouldn’t feed the infant before the procedure. Check with the doctor about what to do to prepare the infant for an upper GI series.

During the procedure, a health care professional will give the infant liquid contrast (barium) in a bottle or mixed with food to coat the inner lining of the upper GI tract. The x-ray technician takes several x-rays as the contrast moves through the GI tract. The technician or radiologist will often change the position of the infant to get the best view of the GI tract. The barium shows up on the x-ray and can help find problems related to GERD.

For several days afterward, the infant may have white or light-colored stools from the barium. A health care professional will give you specific instructions about the infant’s feeding and drinking after the procedure.

Esophageal pH and impedance monitoring

The most accurate procedure to detect acid reflux is esophageal pH and impedance monitoring. Esophageal pH and impedance monitoring measures the amount of acid or liquid in an infant’s esophagus while he or she does normal things, such as eating and sleeping.

This procedure takes place at a hospital or outpatient center. A nurse or physician places a thin flexible tube through the infant’s nose into the stomach. The tube is then pulled back into the esophagus and is secured in place with tape to the infant’s cheek. The end of the tube in the esophagus measures when and how much acid or liquid comes into the esophagus from the stomach. The other end of the tube attaches to a monitor outside his or her body that records the measurements. The placement of the tube is sometimes done while a child is sedated after an upper endoscopy, but can be done while an infant is fully awake.

Most infants will stay overnight in the hospital for 24 hours after the tube is placed.

This procedure is most useful to the doctor if you keep a diary of when, what, and how much food the infant eats and his or her GERD symptoms after feeding. The gastroenterologist can see how the symptoms, certain foods, and certain times of day relate to one another. The procedure can also show whether or not reflux triggers any breathing problems.

April 2015

This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.