Reflux

Written By Brittyn Coleman, MS, RDN/LD

What is Reflux?

  • Gastroesophageal reflux, also called acid reflux, occurs when food or acid from the stomach flows backward up into the esophagus and occasionally into the throat, mouth, and nose. 

  • Some studies report that up to 30% of children with autism experience reflux. It is commonly misdiagnosed, underdiagnosed, or hard to diagnose in children with autism.

  • It is common to have occasional reflux from time to time, but reflux that happens too often can cause poor growth, vomiting, or chronic inflammation of the esophagus.

  • The lower esophageal sphincter (LES) is a ring of muscle that controls the opening between the esophagus and stomach. [6]

    • Reflux happens when the LES muscle relaxes at the wrong time or doesn’t close as it should.

  • Reflux is diagnosed through several methods including [6]: 

    • Barium swallow test

    • Upper endoscopy

    • 24 hour esophageal pH

    • Esophageal motility study

  • In children with autism, gastrointestinal symptoms such as reflux are common. 

    • Reflux is commonly misdiagnosed, underdiagnosed or hard to diagnose in children with autism.

    • One study reported that up to 30%of children with autism experienced gastroesophageal reflux. [7]

  • Many common behaviors such as excessive chewing, regurgitation, or prolonged eating linked to reflux could be overlooked as OCD or developmental or structural concerns.

 

Source: Autism Dietitian Instagram

 

Signs/Symptoms

  • Regurgitation

  • Vomiting

  • Spitting-up

  • Heartburn/Chest pain

  • Picky eating

  • Backwashing

  • Child straining their neck or pushing out jaw

  • Child tapping their throat or chest

  • Constantly clearing the throat

  • Excessive chewing

  • Prolonged eating times

  • Difficulty swallowing

  • Frequent burping

  • Hiccups

  • Sleep disturbances

  • Chronic cough or wheezing that doesn’t respond to asthma medications

  • Irritability and self-injurious behavior

    • Particularly during or shortly after eating

  • Poor weight gain

  • Halitosis (bad breath)

  • Damaged dental enamel

Potential Root Causes

  • Increased abdominal pressure related to:

  • Low stomach acid production

  • Imbalanced gut bacteria

  • High intakes of fatty and fried foods

  • Underlying food sensitivities

  • Certain medications such as antidepressants, antihistamines, asthma medicines, sedatives, and pain relievers. 

  • Small Intestinal Bacterial Overgrowth (SIBO)

  • Helicobacter pylori infection

  • Hiatal Hernia

Next Steps

Nutritional Considerations for Reflux

 
 

  • Limit common foods that can cause reflux such as tomatoes, tomato sauce, spicy foods, high-fat foods, fried foods, garlic and onions, caffeinated drinks, carbonated beverages, chocolate, peppermint, and dairy.

  • Eat fermented foods such as yogurt, kefir, kombucha, kimchi, and sauerkraut. 

  • Eat enzyme-rich foods such as pineapples, papaya, banana, kiwi, apricot, and avocados.

    • When foods are eaten raw or lightly steamed more live natural enzymes are preserved 

    • Fresh pressed fruit juices are a good source of enzymes but should be consumed shortly after extraction because natural plant enzymes break down quickly.

  • Eat fiber-rich foods like whole grains, fruits, and vegetables, chia seeds, flaxseeds, oatmeal, dates, and pears.

    • A high fiber diet increases both frequency and quantity of bowel movements, which can help prevent constipation and bloating which contribute to reflux. 

  • Avoid food sensitivities, food allergies, and known trigger foods. 

  • Eat smaller sized meals

  • Eat slowly

  • Chew well

  • Don’t overeat

  • Don’t eat less than 2 hours before bed

 
 

Supplement Considerations for Reflux

 
 

Lifestyle Considerations for Reflux

  • Maintain a healthy weight

  • Exercise 60 minutes/day

  • Wait at least 3 hours before laying down after eating

  • Speak with your child’s doctor or pharmacist to determine if any current medications are contributing to reflux.

DISCLAIMER: Before starting any supplement or medication, always consult with your healthcare provider to ensure it is a good fit for your child. Dosage can vary based on age, weight, gender, and current diet.

Reflux & Autism in the Research

Prevalence and Identification of Reflux in Children with Autism

  • In this study, parents completed a 17 item screening to determine if their children with autism had any of the common gastrointestinal disorders linked to autism.[7]

  • This screening method identified children having one or more of these disorders with a sensitivity of 84%, specificity of 43%, and a positive predictive value of 67%.

  • This screening tool could be helpful in identifying gastrointestinal concerns in children who are very young, non-verbal, or who have difficulty expressing the source of their pain. 

  • This method of parental screening identified that roughly 30% of children with autism experience reflux.

Reflux and Irritability

  • Children with autism with reflux exhibited unexplained irritability more frequently (43% of the time) than those children with autism who did not have reflux (13% of the time).[1]

  • This study suggests that diagnosing and taking steps to improve reflux may be helpful in resolving irritability in children with autism.

  • [1] Wasilewska J, Klukowski M. Gastrointestinal symptoms and autism spectrum disorder: links and risks - a possible new overlap syndrome. Pediatric Health Med Ther. 2015;6:153-166. Published 2015 Sep 28. doi:10.2147/PHMT.S85717

    [2] Horvath K, Perman JA. Autism and gastrointestinal symptoms. Curr Gastroenterol Rep. 2002;4(3):251–258.

    [3] Acid Reflux: Q&A with GI Specialist Tim Buie. Autism Speaks. https://www.autismspeaks.org/expert-opinion/acid-reflux-qa-gi-specialist-tim-buie. Accessed September 30, 2021.

    [4] Gastrointestinal (GI) Problems in Children with Autism. The Place for Children with Autism. https://theplaceforchildrenwithautism.com/autism-blog/gastrointestinal-gi-problems-in-children-with-autism. Published October 3, 2019. Accessed September 30, 2021.

    [5] ​​Heifert TA, Susi A, Hisle-Gorman E, et al. Feeding Disorders in Children With Autism Spectrum Disorders Are Associated With Eosinophilic Esophagitis. J Pediatr Gastroenterol Nutr. 2016;63(4):e69-e73. doi:10.1097/MPG.0000000000001282

    [6] Denham JM, ed. Gastroesophageal Reflux (for Parents) - Nemours Kidshealth. KidsHealth. https://kidshealth.org/en/parents/gerd-reflux.html. Published January 2021. Accessed September 30, 2021.

    [7] Margolis KG, Buie TM, Turner JB, et al. Development of a Brief Parent-Report Screen for Common Gastrointestinal Disorders in Autism Spectrum Disorder. J Autism Dev Disord. 2019;49(1):349-362. doi:10.1007/s10803-018-3767-7

    [8] Baird DC, Harker DJ, Karmes AS. Diagnosis and Treatment of Gastroesophageal Reflux in Infants and Children. Am Fam Physician. 2015;92(8):705-714.

    [9] McElhanon B, Sharp, Karpen S, McCracken C. Gastrointestinal symptoms in autism spectrum disorder: A meta-analysis. Pediatrics. https://pubmed.ncbi.nlm.nih.gov/24777214/. Accessed October 2021. 

    [10] Madra M, Ringel R, Margolis KG. Gastrointestinal issues and autism spectrum disorder. Child and adolescent psychiatric clinics of North America. https://pubmed.ncbi.nlm.nih.gov/32471598/. Accessed October 2021. 

    [11] Neiworth-Petshow EM, Baldwin-Sayre C. Naturopathic Treatment of Gastrointestinal Dysfunction in the Setting of Parkinson's Disease. Integr Med (Encinitas). 2018;17(4):44-50.

Authors

Brittyn Coleman, MS, RDN/LD, CLT

Sinead Adedipe, MS

Brittyn Coleman, MS, RDN/LD https://www.autismdietitian.com
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