Etiology
Many factors contribute to the development of GERD. Neurologic impairment, such as cerebral palsy, Down syndrome, and head injury, may affect the transmission of neural signals to the lower esophageal sphincter (LES). Delayed gastric emptying of a liquid meal because of distention may contribute. Partial or incomplete swallowing dysfunction or drugs such as theophylline or caffeine can also trigger LES relaxations. Increased intraabdominal pressure incurred while straining, crying, coughing, or slumping tends to promote increased epicontributing factors of GER. These postural effects are most likely primary contributing factors in infants. Obesity and hiatal hernias also promote GERD. Finally, during the first 6 months of life, the LES pressure undergoes maturational development. Because infants have a short abdominal LES, they have GER more often. As the infant grows, the LES matures and the reflux improves. The prognosis is likely related to the severity of symptoms. Reflux from maturational causes will likely resolve by 1 to 2 years of age.