Expert diagnosis and treatment for children with hiatal hernia, which can occur in children with the airway condition esophageal atresia

For children with a hiatal hernia the Esophageal and Airway Treatment team at Johns Hopkins All Children’s Hospital in St. Petersburg, Florida, provides expert diagnosis and treatment. 

What is pediatric hiatal hernia? 

A hiatal hernia occurs when part of the stomach pushes up through an opening in the diaphragm and into the chest. This opening is usually located where the esophagus joins the stomach.

Some patients may develop a hiatal hernia as a complication from a previous surgery to correct esophageal atresia, in which part of the esophagus is missing. Repairing esophageal atresia involves a surgical procedure to connect the two unconnected segments. A hiatal hernia can develop if the ends of the esophagus are ultimately too short to be properly rejoined. This can lead to reflux, which, if not properly treated, can cause chronic esophageal damage and even cancer later in life. 

What are the symptoms of pediatric hiatal hernia? 

Symptoms of a hiatal hernia typically mimic those of acid reflux, including a burning sensation in the chest (heartburn), chest pain, trouble swallowing, or regurgitation of food or liquid.

When children who have been on multiple medications for reflux are still having issues with reflux, this may be a sign of hiatal hernia.

How is pediatric hiatal hernia diagnosed? 

A test called esophagogastroduodenoscopy or EGD is used to diagnose a hiatal hernia. An EGD allows us to examine your child’s esophagus, stomach and part of the small intestine. We use a special type of contrast dye that distinguishes gastric (stomach) cells from esophagus cells to determine the severity of the hiatal hernia. 

How is pediatric hiatal hernia treated? 

Treatment depends on your child’s individual condition. Children don’t always need surgery for a more minor hiatal hernia. If your child does need surgery, the hiatal hernia is repaired by moving the stomach back down under the diaphragm and repairing the opening, as well as performing a procedure to control reflux. In the setting of esophageal atresia, hiatal hernia repairs are more prone to complications when treated by teams with less esophageal atresia expertise. 

Follow-up care

After your child’s surgery, our team will continue to monitor their condition as needed, depending on their individual needs. As hiatal hernia is typically associated with esophageal atresia, your child will continue to receive the care needed for their condition and we will monitor for reflux as part of their follow-up care. Learn more about treatment and follow-up care for esophageal atresia.