Diagnosis of Hiatal Hernia

Your child’s pediatrician (doctor who specializes in treating children) will likely refer your child to a specialist (either a gastroenterologist or a pediatric surgeon). These providers will order one or more of the following tests to confirm a hiatal hernia in your child:

• Imaging. An X-ray imaging test creates detailed pictures of the inside of your child’s body. Your child may also need to undergo an upper GI series, which is a series of X-rays as your child swallows contrast dye.
• Upper endoscopy. This test uses a tiny camera attached to a thin tube to closely examine the upper portion of your child’s digestive tract. The gastroenterologist threads the camera down your child’s throat. Your child will receive medicine to help relax and decrease pain during this test.
• Esophageal manometry. This test measures the muscle contractions of your child’s throat while they swallow.

Treatments for Hiatal Hernia

If your child’s hiatal hernia is mild and not causing symptoms, they may not need treatment.

If your child’s hiatal hernia is causing symptoms, they will likely need surgery. This surgery is often done at the same time as an “anti-reflux” procedure called a Nissen fundoplication. Typically, these surgeries are performed using minimally invasive, laparoscopic (inserting a small camera in the body) techniques. Your child will be under general anesthesia (fully asleep) for the procedure.

During the surgery and depending upon your child’s unique situation, the surgeon may:

• Make the hiatus (diaphragm opening) smaller by stitching it closed
• Pull the stomach down into the abdomen
• Remove the sac-like area pressing through the diaphragm (hernia sac)

After surgery, your child will spend several hours in a recovery area. Their care team will closely monitor them as they wake up from the anesthesia. Your child will likely spend a few days in the hospital for recovery.

Home remedies

The following lifestyle changes may help control your child’s symptoms prior to undergoing surgery, or if the symptoms are mild and don’t require surgery:

• Avoiding foods that can cause heartburn, including:
  
  • Caffeine
  • Chocolate
  • Fried food
  • Garlic
  • Mint
  • Onion
  • Tomato sauce
• Eating smaller amounts of food throughout the day, instead of three larger meals
• Elevating the head off the bed at least six inches
• Not eating three hours before going to bed
• Not laying down immediately after eating
• Taking over-the-counter heartburn medications