Does your child have persistent vomiting, coughing, or discomfort after feeding? Your paediatrician may mention GERD—a condition where stomach acid frequently flows back into the food pipe. Currently, diagnosing GERD in young children involves uncomfortable monitoring tubes placed down the throat for 24 hours. New research from China suggests a simpler alternative: a breath test.
Researchers studied 159 children with suspected GERD to see whether measuring fractional exhaled nitric oxide (FeNO)—a substance in breath—could help identify the condition. This test works like a quick screening tool, particularly for children under 5.
Children with reflux have significantly higher nitric oxide in their breath
Among the 101 children under age 5 in the study, those with GERD had breath nitric oxide levels nearly double those without GERD (18 compared to 10 units). The higher the nitric oxide level, the more severe the reflux episodes tended to be. The test showed good ability to rule out GERD: when breath nitric oxide was below a certain threshold, doctors could be fairly confident the child didn't have the condition.
The test works well for pre-nursery children, but not older kids
Importantly, the breath test showed clear benefits only for children under 5 years old. For children aged 5 and above, there was no consistent advantage. This timing matters for Singapore families, since the test could be most useful during your child's pre-nursery and early nursery years when GERD is still common.
A gentler first step, but not the final answer—yet
The breath test correctly identified only about half of the children who actually had GERD. This means it's useful for ruling out reflux when the result is negative, but doctors would still need additional tests to confirm GERD when the breath test suggests it's present. If adopted in Singapore hospitals, the test could serve as an initial screening step, helping paediatricians decide which children need more invasive investigations rather than putting all children through uncomfortable monitoring tubes immediately.
If your child shows signs of reflux
- Ask your paediatrician whether a breath test for nitric oxide is available as a first screening step before any invasive monitoring.
- If your child is under 5 with suspected reflux symptoms, mention this research when discussing testing options with your doctor.