Gastroesophageal Reflux (GERD) The regurgitation of gastric contents back up into the esophagus. It is the result of relaxation or incompetence of the lower esophageal neuromuscular function or incompetence of the lower esophageal (cardiac) sphincter. It occurs at any time and is not necessarily related to having a full stomach. The regurgitation of gastric contents back up into the esophagus. It is the result of relaxation or incompetence of the lower esophageal neuromuscular function or incompetence of the lower esophageal (cardiac) sphincter. It occurs at any time and is not necessarily related to having a full stomach. Some “spitting up” is normal in infants because of weakness in the esophageal (cardiac) sphincter. If regurgitation continues and increases in frequency it can be considered reflux. Some “spitting up” is normal in infants because of weakness in the esophageal (cardiac) sphincter. If regurgitation continues and increases in frequency it can be considered reflux.

Gastroesophageal Reflux (GERD) ETIOLOGY & PATHOPHYSIOLOGY: Exact cause is unknown, but it is believed to be a result of delayed maturation of the lower esophageal neuromuscular function or impaired hormonal control mechanisms. Exact cause is unknown, but it is believed to be a result of delayed maturation of the lower esophageal neuromuscular function or impaired hormonal control mechanisms. Repeated reflux (backward flow) of gastric contents can damage delicate esophageal mucosa. Repeated reflux (backward flow) of gastric contents can damage delicate esophageal mucosa.

GERD GERD in children is usually self-limiting and resolves spontaneously by age the age of 1 year. Treatment depends on the severity of the condition. Some children only require a modification of feeding habits, thickening of feedings with rice cereal (controversial, this recommendation changes constantly), treatment with cholinergics, antihistamines, antacids and histamine antagonists (pepcid, zantac, tagamet, reglan, propulsid, maalox). GERD in children is usually self-limiting and resolves spontaneously by age the age of 1 year. Treatment depends on the severity of the condition. Some children only require a modification of feeding habits, thickening of feedings with rice cereal (controversial, this recommendation changes constantly), treatment with cholinergics, antihistamines, antacids and histamine antagonists (pepcid, zantac, tagamet, reglan, propulsid, maalox).

GERD In severe cases (if child is aspirating stomach contents and gastric fluid in to lungs) child may require surgery, this surgical procedure is called a Nissan fundoplication, in which the gastric fundus (the greater curvature of the stomach) is wrapped around the distal esophagus. Postoperatively after a Nissan the child will have a gastrostomy tube in place for approximately 6 weeks post op. In severe cases (if child is aspirating stomach contents and gastric fluid in to lungs) child may require surgery, this surgical procedure is called a Nissan fundoplication, in which the gastric fundus (the greater curvature of the stomach) is wrapped around the distal esophagus. Postoperatively after a Nissan the child will have a gastrostomy tube in place for approximately 6 weeks post op.

Nursing Assessment - GERD Assessment Frequent vomiting with bloody vomitus Frequent vomiting with bloody vomitus Hiccupping Hiccupping Aspiration and frequent respiratory infections Aspiration and frequent respiratory infections Recurrent otitis media Recurrent otitis media ALTE ALTE Cyanotic episodes Cyanotic episodes Anemia secondary to blood loss. Anemia secondary to blood loss. The most important Nursing intervention is to prevent aspiration

Nursing Interventions - GERD Nursing Interventions: Treatment and nursing intervention depends on the severity of disease. Treatment and nursing intervention depends on the severity of disease. Strict I&O Strict I&O Document Amt, frequency, characteristics of Vomitus, Document Amt, frequency, characteristics of Vomitus, Small frequent feedings Small frequent feedings Thicken formula with RC (if ordered) Thicken formula with RC (if ordered) Place child at 30 – 45 degree angle after feedings Place child at 30 – 45 degree angle after feedings Avoid citrus fruits & juice Avoid citrus fruits & juice Family education Family education

GERD The most important Nursing intervention is to prevent Aspiration.