Key elements of history in child with suspected gastroesophageal reflux disease

Symptoms suggesting GERD

Discomfort or irritability (if this is the only symptom in an infant, it is unlikely to be due to GERD)

Heartburn, chest pain, or epigastric abdominal pain

Recurrent hematemesis

Acid brash, regurgitation (often triggered by recumbent position, food, activity, or anxiety), or "wet burps"

Nocturnal cough

Chronic sore throat

Rapid relief of symptoms when taking antacids or acid-suppressing medications

Dystonic posturing (Sandifer syndrome)

Wheezing, stridor, or hoarseness

Symptoms increase after large meals

Constipation

Signs suggesting GERD

Erosion of tooth enamel, mainly on the palatal aspects of the maxillary teeth

Unexplained iron-deficiency anemia

Esophagitis, esophageal stricture, or Barrett's esophagus on diagnostic testing

BRUE

Asthma

Recurrent aspiration pneumonia

Recurrent otitis media

Symptoms less commonly attributable to GERD

Dysphagia or odynophagia*

Failure to thrive or weight loss

Feeding refusal/aversion^¶

School absences

Anxiety/depression

Marijuana use (heavy, daily use may be associated with hyperemesis)

GERD: gastroesophageal reflux disease; BRUE: brief resolved unexplained event.
* Patients with dysphagia (difficulty swallowing) or odynophagia (pain with swallowing) usually should undergo a specific evaluation, as described in the topic text. In adolescents, odynophagia is often associated with pill esophagitis or a viral infection of the esophagitis.
¶ Food aversion may be associated with GERD in toddlers or eosinophilic esophagitis in young children. Psychosocial stressors should also be considered.

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Key elements of history in child with suspected gastroesophageal reflux disease