Gastroesophageal Reflux Disease and Treatment Options

Gastroesophageal reflux (GER) occurs when a small amount of acidic stomach fluid or food in the stomach goes back up into the esophagus (swallowing tube). This is a normal process with symptoms including regurgitation or pain that can be experienced several times a day, especially after eating, and usually lasting less than three minutes. Some individuals with GER will have no symptoms. GER occurs in more than two-thirds of healthy infants, and half of these infants experience regurgitation or “spitting up” that spontaneously resolves without medication by approximately 1 year of age. A pediatrician or gastroenterologist should evaluate children whose symptoms worsen or do not resolve by the time they are 12-18 months of age.

When to see a doctor
When the reflux causes intolerable discomfort or complications, patients should be evaluated by a doctor for gastroesophageal reflux disease (GERD). GERD in infants is treated with a lifestyle modification approach. Children and adolescents can also be treated with medicine. In rare cases, surgery may be needed.

Lifestyle modifications
If you think your child may have GER or GERD, discuss it with your pediatrician. He or she may recommend lifestyle modifications:

  • For infants
    • Change in milk formulation
    • Hold your infant in an upright position after feedings
    • Avoid placing your infant in a car seat after a meal
  • For children and adolescents
    • Avoid large meals
    • Do not lie down immediately after eating
    • If obese or overweight, lose weight
    • Avoid foods and drinks that can cause acid reflux, such as garlic, peppermint, caffeine, tomatoes, chocolate, citrus fruits, alcohol and spicy foods

Doctors may prescribe medications that lower the amount of acid in the stomach to alleviate symptoms of GERD:

  • Tums (calcium carbonate)
  • Milk of Magnesia (magnesium hydroxide)
  • Pepcid (famotidine)
  • Zantac (ranitidine)
  • Prilosec (omeprazole)
  • Prevacid (lansoprazole)
  • Nexium (esomeprazole)
  • Aciphex (raberprazole)

Remember to always consult your child’s pediatrician, gastroenterologist or pharmacist before starting any medication.

Warning signs or symptoms that immediately require further medical evaluation:

  • Weight loss
  • Seizure
  • Abdominal distention
  • Green or red vomit
  • Persistent forceful vomit

It can be helpful to keep a diary of GERD symptoms. Record your child’s symptoms and bring the diary to doctors’ appointments. This information can help the doctor determine what is causing GERD symptoms and provide better care for your child.

Avoid Becoming Thank-“full” this Holiday

By Sarah Kavlich, RD, CLEC, clinical dietitian at CHOC Children’s 

Today, in many American households, the Thanksgiving celebration is centered on gratitude and sharing a bountiful meal with family and friends. The star of the Thanksgiving meal is arguably a stuffed turkey; and often times after a day of feasting, that may not be too far off from the way we feel. You and your family can avoid overeating this holiday season with these easy steps:

  • Eat breakfast! Although known as the most important meal of the day, it is often thrown by the wayside, especially when we anticipate a larger meal to come. Instead, have a light breakfast before your feast, which can help keep you from overdoing it later.
  • Use smaller plates. We eat with our eyes and when we see a large plate with a lot of empty space, our brain has a tendency to think we are still hungry once we are finished. Instead, serve your appropriate portions on a smaller plate. Once you’ve finished your meal, you’ll be able to listen to your stomach when it tells you you’re full.
  • Load up on non-starchy veggies like salad and green beans. These sides can offer plenty of fiber, which can fill you up with out adding extra calories. If you are the cook, try a new spin on green bean casserole (see below), with all of the traditional flavors but without all of the traditional fat.
  • Hold the gravy. Did you know that gravy alone can add up to 170 calories in a half cup? Try your meal without it this year.
  • Skip the seconds. Just because it’s a holiday doesn’t mean your health goals need to take a holiday too. Focus on visiting with friends and family and not just eating. If you are truly still hungry later in the day, have a light snack to hold you over.
  • Stay active. Use this opportunity to spend time with those you love by going on a walk together before or after your meal.

Green Beans with Shallots and Almonds
2 pounds green beans, cut into 1 inch pieces
2 tablespoons olive oil
2 cups sliced shallots (about 4 large)
2 tablespoons unsalted butter, at room temperature
1/2 cup sliced almonds, toasted

Fill a large bowl with ice cubes and water. Bring a large pot of salted water to a boil. Add green beans to pot and cook until crisp-tender, about 5 minutes. Drain and plunge beans into an ice bath. Drain beans again and dry on paper towels.

Warm olive oil in a large skillet over medium heat. Add shallots and sauté until softened and lightly browned, about 7 minutes. Add green beans and butter and cook until beans are heated through, about 2 minutes. Sprinkle with toasted almonds and serve.

Yield: 8 servings, 150 calories, 10g fat, 4g protein, 14g carbohydrate, 4g fiber, 8mg cholesterol, 164mg sodium. Source:

Learn more about CHOC Clinical Nutrition and Lactation Services.

CHOC Children’s Gives Thanks

The community of physicians, staff, patients and special visitors at CHOC Children’s has much to be thankful for this year. In addition to launching our Trauma Center and our Mental Health Initiative, we’re thankful to be able to offer best-in-class care to kids in Orange County and the greater community. A few members of our CHOC family share what they are most thankful for this year.

Berkeley, Pet Therapy Dog 

Pet therapy dog“I am so grateful for the privilege of visiting patients and families at CHOC Children’s. No bone, dog park visit, or belly scratch brings me as much happiness as seeing a smile stretch across a patient’s face when I visit. Thanksgiving especially reminds me that the CHOC canine crew is one lucky pack!”

Kimberly Chavalas CripeKim Cripe
President & CEO

“I am grateful for the privilege of working alongside the most compassionate, dedicated and brilliant team of clinicians and staff. I have the honor of witnessing our physicians, researchers and nurses advance innovative and life-saving care, securing bright futures for our community’s children. And I am humbled by the courage of our patients, who inspire me each and every day to push the limits of what is possible for them and their families.”

David DukesDavid Dukes
Chair, CHOC Children’s
Board of Directors

“I am thankful to reside in a county that is home to an excellent children’s healthcare system, and honored for the opportunity to help guide CHOC towards its vision to be a leading destination for children’s health by providing exceptional and innovative care.”


Melanie PattersonMelanie.PattersonIMG_0292_2
Vice President, Patient Care Services & Chief Nursing Officer

“I am thankful for the amazing patient care staff we have at CHOC.  All are committed to every patient and family that walks in the campus.”



Lindsey Clark
Child Life Specialist

“I am thankful for a wonderful team of child life specialists. I could not do my job without each one of them. Thank you for your support, encouragement, wisdom and laughter each and every day. Each of you are making CHOC a place where kids feel safe and would want to visit again.”

Choco Bear, Beloved Mascotchoco bear

“I am thankful for weak tree branches. Yes, really! If I hadn’t fallen out of that tree so many years ago and hurt my arm, I never would have met the wonderful people at CHOC Children’s. Not only did they fix me up, but they started my longtime friendships with CHOC doctors, staff, patients and families. These relationships continue to grow and deepen every day, and I am one grateful bear.”

Dr. Nick Anas
Pediatrician-in-Chief and Medical Director, PICU

Nick Anas

“As I reflect upon the last year, I am most thankful for the incredible support and confidence provided to me by both CHOC administration and the pediatric intensive care unit team of physicians, nurses, and specialty staff with whom I have worked for so many years. It’s awe-inspiring to witness and to be part of a collaboration that is committed to excellence in the care of our patients and their families. As we approach this holiday season, I am so proud that CHOC is here to protect the health of our children.”

mom of Jordin, age 8

“I am thankful for all the employees and volunteers at CHOC, and their commitment to keeping Jordin healthy, safe and happy. This year has been one of her most challenging years with sickle cell disease. CHOC Children’s Hospital and CHOC Children’s Foundation was there for Jordin and our family to help us see through some of our darkest moments. Without CHOC we would not be able to raise Jordin to be a strong healthy young lady.”

Bill Holmes, Donor

Bill Holmes

“I am thankful for my success in business because it has given me the opportunity to support wonderful organizations, like CHOC.”

Alan Ramirez
CHOC Patient, age 10

“I’m grateful for my nurses because they help me with my medicines.”




Marion Van Eeden - CCMH GP of the YearMarion Van Eeden
Clinical Nurse, Pediatrics,
CHOC Children’s at Mission Hospital

“I’m so thankful for the privilege to work at CHOC Children’s at Mission Hospital and for being a part of such a wonderful team that provides excellent family-centered care for our pediatric patients. “

A Teenager With Epilepsy: Stephen’s Story

In Recognition of Epilepsy Awareness Month, we spoke with a teenager with the condition to learn more about life with epilepsy, and what advice he would offer a newly diagnosed patient.

Stephen Moore

Stephen Moore swallows eight pills daily, avoids heights and contact sports, and pays close attention to his body’s cues. This routine, combined with the care of CHOC Children’s specialists, has helped keep the 15-year-old seizure-free since his epilepsy diagnosis three years ago.

Stephen is one of 2.5 million Americans with epilepsy, a neurological condition wherein abnormal electrical activity in the brain can cause seizures, convulsions or sensory disturbances.

He was diagnosed at age 12 after experiencing a seizure one Sunday afternoon while watching a football game on television with his parents.

“I got up, took a step forward and collapsed on the ground,” he says. “My parents wanted to know if I was alright and what was going on. I could hear them, but I couldn’t respond. It was like the muscles in my jaw just weren’t there and I couldn’t move them.”

An ultimate epilepsy diagnosis and subsequent care plan was at first confusing and distressing for Stephen.

“I got the feeling that all kids who are newly diagnosed get,” he says. “Your heart sinks. You hear, ‘You can’t do this, you can’t do that,’ and it’s like, ‘What am I supposed to do?’”

For Stephen, the “can’ts” include activities that involve heights, like rock climbing or a pool’s high-dive. He can’t swim alone and must always wear a helmet while bicycling – good advice for everyone – and he must also pass on contact sports, like football.

For the then 12-year-old Stephen, these restrictions at first seemed insurmountable.

“It was very depressing,” he said. “But I’ve gotten through it. It took some time, about two months after I was diagnosed.”

Now, three years later, Stephen has mostly made peace with his condition, which could become life-long. His advice to newly diagnosed patients would be to listen to their bodies’ needs and talk to people about the condition. These measures help him maintain both physical and emotional health.

“At first, I was afraid to talk to anyone,” he said. “I don’ t know if I didn’t want people to know or I just didn’t want to think about it myself, but I learned that you definitely need to talk about it, otherwise you’ll bottle that up.”

A freshman in high school, Stephen is enrolled in honors and AP courses and particularly enjoys Spanish class. His teachers and a few friends know about his condition, but he doesn’t let epilepsy and the threat of another seizure rule his life.

“I don’t worry about that,” he says. “I know I have it and seizures can happen, but I don’t think about it because it does me no favors.”

Learn more about CHOC Children’s comprehensive epilepsy program.

Pediatrics Article Highlights Big Outcomes in CHOC’s Small Baby Unit

CHOC Children’s Small Baby Unit (SBU) is improving quality and outcomes in extremely low birth weight (ELBW) infants (babies born at 28 weeks gestation or less and weighing less than 1,000 grams), according to results of an article CHOC physicians and staff published in a recent issue of Pediatrics.

“In recent years, the survival rates for ELBW infants have improved with the latest advances in neonatal intensive care, but many are still released from the hospital with significant challenges, including neurodevelopmental delays and/or chronic medical problems,” said Mindy Morris, DNP, the SBU program coordinator and the article’s co-author. “Our goal was to improve these outcomes by utilizing a dedicated team with expertise in the care of these patients.”

The objective of the CHOC neonatology team was to care for ELBW infants in a single location physically separated from the main Neonatal Intensive Care Unit (NICU). This space became the 12-bed SBU, which consisted of four individual patient rooms, two of which are surgical suites, and three four-bed pods. Different from a traditional NICU, this smaller unit allows for a darker, quieter environment that encourages developmentally supportive care. The goal is to create an environment that respects and supports the physiologic needs of the baby to grow and develop after being born so prematurely. Grouping this population also provides parents an opportunity to form strong bonds with other families sharing similar experiences.

Outcomes from the two years before and four years after the SBU’s opening in March 2010 include:

• Reduction in chronic lung disease from 47.5 percent to 35.4 percent. A common condition for premature babies, chronic lung disease can have long-lasting ramifications including re-hospitalization and poor neurodevelopment.

• Rate of hospital-acquired infection decreased from 39.3 percent to 19.4 percent.

• Infants being discharged with growth restriction (combined weight and head circumference, < 10th percentile) decreased from 62.3 percent to 37.3 percent. (These factors are linked to cognitive and physical disabilities.)

• Reduction in laboratory tests (from 224 to 82) and X-rays (from 45 to 22).

Additionally, there was a reduction in illness and complications among infants after leaving the SBU.

Moving forward, the SBU’s goal is to continue to improve patient outcomes, as well as family and staff satisfaction, while also becoming a destination for the care of extremely preterm infants.

CHOC’s NICU Is Expanding to Better Serve the Families of OC and Beyond

NICU expansionFor several decades, CHOC Children’s has offered highly specialized care for the most critically ill babies. CHOC’s neonatal intensive care unit (NICU) proudly offers 67 beds in Orange, 22 beds in Mission Viejo, and a team of premier neonatologists who provide coverage at hospitals throughout Southern California.

To enhance our patient- and family-centered care experience and meet the growing demand for services, CHOC will expand its NICU with the build out of 36 private rooms, with potential for more beds in a second construction phase. Located on the fourth floor of the state-of-the-art Bill Holmes Tower, the expanded unit is scheduled to open in summer 2017.

Private NICU rooms are setting a new standard for improved patient outcomes. A recent study published in the journal Pediatrics found that infants cared for in single-family rooms weighed more at discharge and gained weight more rapidly than those cared for in an open design. Also, they required fewer medical procedures, had increased attention, and experienced less stress, lethargy and pain. The researchers attributed these findings to increased maternal involvement.

Further, the private-room setting provides the space and privacy that parents need in order to be more intimately involved in the care of their baby, including breastfeeding and skin-to-skin contact, and parents can actually spend the night with their child. In addition, private rooms give staff more access to and interaction with the family and patient.

The unit will also feature a multipurpose family room, additional office space and other enhanced amenities.

CHOC’s NICU was recently named one of the nation’s “top 25” by U.S. News & World Report, reflecting the NICU team’s unwavering commitment to the highest standards of patient care and safety.

Learn more about our NICU expansion plans. 

Helping Siblings Cope with the NICU

Helping siblings cope with the NICUWhen one child is hospitalized, it can affect the entire family. A patient’s siblings can feel confused, jealous, angry, or even guilty over the hospitalization of their brother or sister, especially when it’s a new baby.

Toddlers and preschoolers can have an especially hard time coping with mom and dad being away. To cope with this jealousy, try to keep their daily routine as normal as possible. Spending one-on-one time with the Neonatal Intensive Care Unit (NICU) baby’s older sibling is important for maintaining a sense of normalcy. Even brief amounts of regular time can help maintain a sense of fun and family.

No matter their age, it’s important to remind siblings that it’s not their fault that new baby is in the NICU. Sometimes little minds can run wild, and it’s essential to remind them that they did nothing wrong to cause their brother or sister to stay in the NICU.

Parents can address some of siblings’ most common questions about the NICU:

  • “Why is the baby so small?”
    • Babies stay in their mommy’s tummy for nine months so they can grow and get ready to come out. But some babies come too soon and don’t have enough time to grow inside mommy’s tummy. They are very tiny because they came too fast.
  • “Why is my baby in a box?”
    • Educate little ones that incubators are special beds for small babies to keep them safe.
  • “What are all these machines?”
    • Tubes help get the food right to the baby’s tummy so they don’t have to do any work.
    • The baby is small and needs to rest, so tubes help the baby take deep breaths without having to do any work.
    • These machines are helping the baby.

Giving a “job” to siblings can also help them cope and make them feel like they are contributing to the baby’s care. When they’re at home, siblings can make a card or draw a picture that mom or dad can bring to the NICU. Remind siblings that the new baby knows their brother or sister’s voice, so reading or singing quietly to the baby can let them know they are there. Sibling education classes can teach big brothers and sisters how to help mom and dad change a diaper, or feed a bottle to their new baby brother or sister.

Siblings are able to participate in special activities organized by CHOC Children’s child life specialists. Volunteers are on-call to play with siblings or escort them to organized activities when mom or dad needs to be alone with the NICU baby. For more information about other ways CHOC Child Life can help families navigate their experience in the NICU, call 714-509-8473.

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CHOC Supporter Sandy Segerstrom Daniels to Be Honored on National Philanthropy Day

Sandy Daniels

CHOC Children’s supporter Sandy Sergerstrom Daniels will be honored with a Legacy Award for her philanthropic work with CHOC and other Orange County organizations at a National Philanthropy Day luncheon on Nov. 19 at the Hotel Irvine.

Sandy, a children’s advocate and C.J. Segerstrom & Sons managing partner, recently donated a $5 million lead gift to help establish the CHOC Children’s Mental Health Inpatient Center for children ages 3-18. When Sandy learned about the lack of psychiatric inpatient beds and services for children under the age of 12 in Orange County, she was deeply inspired to help.

The new center is the cornerstone of CHOC’s transformative initiative to ensure children and adolescents with mental illness receive the health care services and support they currently lack in Orange County’s fragmented system of care.

Sandy’s relationship with CHOC goes back about two decades, starting with her participation in the CHOC Follies, a beloved annual musical put on by community members to raise money for CHOC. This allowed her to combine her love of theater with her passion for helping children. Today, as co-chair of this special event, Sandy can be found on stage every year singing and dancing alongside other CHOC volunteers, who have helped raise nearly $8 million for CHOC.

Yet, her bond with CHOC is most evident perhaps through her own experience of having had a loved one receive care at CHOC.

“My granddaughter was only two days old when she went to CHOC,” she said. “It wasn’t just about the level of care she received, but how they took care of my daughter and son-in-law too – that’s what CHOC is all about. It’s specialized care and specialized, caring people. Supporting CHOC has been a labor of love for me ever since.”

Sandy’s life-changing work with CHOC and countless organizations in the community is a testament to her commitment to improving the lives of children and their families.  She will be recognized along with eight other honorees at the upcoming luncheon.

National Philanthropy Day Orange County honors individuals, businesses and organizations that have demonstrated philanthropy and enhanced their communities and the world.

Navy Veteran Now Serves CHOC Patients

In honor of Veteran’s Day, we spoke to Navy Veteran Danny Rodriguez, a clinical associate in CHOC Children’s recovery room (PACU). After a near-drowning accident when he was 4 years old, Danny was hospitalized at CHOC. Years later, he returned to the hospital as an employee to help other patients the way he’d been cared for. CHOC is proud to have numerous veterans on staff taking care of our patients.

Q: What role do you play in caring for patients at CHOC?

A: As a clinical associate, I assist nurses by taking patients’ vital signs in the pre-operative unit, and by helping patients be discharged from the recovery room. Before transferring to this department, I worked in central transport for two years, helping ensure all departments, including surgical services, had the medical supplies and equipment they needed, when they needed it. We also worked hard to ensure special patient care needs were met promptly and efficiently.

Q: What aspect of your role as a clinical associate are you most passionate about?

A: I’m the first one to see kids when they come in for surgery. I get to find out what they like and talk to them about it, to make sure they’re comfortable. Sometimes I’m able to see them before and after their surgery. Everyone does such a great job here at CHOC, but parents and kids like it when they see familiar faces.

Q: How have your experiences in the military prepared you for your healthcare career at CHOC?

A: My experiences in combat have taught me to expect the unexpected. I’ve been deployed three times, and I’m the first line of care for my artillery unit. Going back to the Spanish War, every generation in my family has had someone in the military. But I’ve always wanted to work with kids, and during my deployment to Iraq, I had some experience treating kids. When I got off active duty and joined the Navy Reserve, I had the chance to come to CHOC and give back to the organization that helped me as a child.

Q: What advice would you offer someone considering a career in healthcare?

A: Come to work always ready to have fun and keep a smile on your face!

Q: How do you cope with juggling two roles, in the Navy Reserves and at CHOC?

A: I love to be on the go, but I couldn’t do it without my wife. She’s my rock. When I’m not at work, I coach football, and play competitive rugby and softball.

Preparing Siblings for Visiting the NICU

Mom and dad aren’t the only ones who expected to bring a new baby home from the hospital.  Siblings have also been prepared for the arrival of a baby brother or sister, and often struggle with visiting the newborn in the hospital.  There are several things parents can do to prepare their older children for that first visit to the neonatal intensive care unit (NICU).

Be as honest as possible with your children, since kids overhear and see more than adults realize. Parents often feel the need to protect their other children by not providing a lot of information, but kids’ imaginations can run wild in the absence of facts.  Providing age-appropriate updates on baby’s care can actually help mitigate stress and anxiety when visiting the NICU.

Talk to siblings about what they will see and hear in the NICU. They may see a lot of people, but they’re all there to help the babies. Tell them how the baby will look. Although it’s a quiet area of the hospital, they may hear unexpected noises, like beeps from a monitor or a humming from a ventilator. Remind little ones that these machines and noises are there to help the nurses care for the baby.

Before siblings are allowed in the NICU, they must:

  • Wash hands
  • Speak in a quiet voice
  • Use gentle touches, if permitted to touch the baby

Kids should also be up-to-date on vaccinations, and not have a runny nose or any other symptoms of an illness.

Reading certain age-appropriate books with information on and pictures of NICUs can also help prepare siblings before they visit the NICU for the first time. Several books used by CHOC Children’s Child Life Specialists are:

Before their first NICU visit, big brothers and sisters can participate in medical play activities organized by child life specialists. Being able to touch and see the same items that are used on the baby can help them prepare for and process what they’ll see.  For more information about programs offered for siblings, please call 714-509-8473.

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