A hiatal hernia occurs when a part of the stomach pushes up through the diaphragm.

The diaphragm is the muscle that separates the chest from the abdomen. The cause of hiatal hernias is unknown, but children with this condition are usually born with it. It usually is associated with gastroesophageal reflux in infants.

The symptoms are heartburn, especially when bending over or lying down, swallowing problems, chest pain and burping. Many times, there are no symptoms.

To diagnose a hiatal hernia, the doctor may order a barium swallow.

The treatment goal is to decrease the symptoms and to prevent problems. The doctor may order medications to reduce the stomach acid or to strengthen the sphincter, or gate, between the stomach and the esophagus. The doctor also may recommend sitting upright for an hour after meals. Most of the time, this works.

If these treatments do not work, and surgery is necessary, the surgeon will make a laparoscopic incision in the middle of the chest. This means three to four small puncture holes. The doctor will work to make the opening between the stomach and the chest smaller, so that the stomach cannot slip up into the chest. He or she also may stitch the stomach into place to keep it where it belongs. This is done with the child under general anesthesia.

Children may need to spend as long as a week in the hospital after surgery. A tube will be placed into the stomach to rest the stomach and esophagus while it heals.

For an appointment with a Washington University pediatric surgeon, call (314) 454-6022, Monday-Friday, 8 a.m.-5 p.m.