Gastroesophageal Reflux Disease In Children

Gastroesophageal reflux is passage of gastric contents into the oesophagus and is physiologically common in infancy. Gastroesophageal reflux disease is reflux causing troublesome symptoms, feeding problems, poor growth, oesophagitis or other complications.

Uncomplicated infant regurgitation usually resolves spontaneously as the lower oesophageal sphincter matures and solid feeding and upright posture increase.

Infants may have:

• Frequent regurgitation or vomiting
• Feeding distress
• Feed refusal
• Poor weight gain
• Irritability associated with feeds

Older children may report:

• Heartburn
• Retrosternal pain
• Epigastric pain
• Acid regurgitation
• Dysphagia

Bilious vomiting, haematemesis, forceful projectile vomiting, abdominal distension, neurological abnormalities or faltering growth requires investigation for another diagnosis.

Diagnosis is usually clinical.

Do not routinely investigate a thriving infant with effortless regurgitation.

Upper gastrointestinal contrast studies do not diagnose reflux reliably and should instead be used when anatomical obstruction is suspected.

Oesophageal pH impedance monitoring and endoscopy are reserved for persistent, complicated or diagnostically uncertain disease.

• Reassure parents of thriving infants with uncomplicated regurgitation.

• Review feed volume and avoid overfeeding. Smaller, more frequent feeds may reduce regurgitation.

• Thickened feeds can be considered when troublesome regurgitation persists.

• Do not prescribe proton pump inhibitors solely for isolated infant regurgitation.

• For persistent heartburn, epigastric pain, feeding difficulty or faltering growth where acid related disease is suspected, consider a 4 week PPI trial, then reassess response.

• Omeprazole approximately 1 mg/kg PO once daily, maximum commonly 20 mg/day in younger children, is a practical starting regimen.

Persistent dysphagia, gastrointestinal bleeding, poor growth or failure of appropriate therapy warrants specialist assessment and possible endoscopy.