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11/13/24, 8\:19 PM Guide | Paediatric GORD explanation

Paediatric GORD explanation

Table of contents

Opening the consultation

Wash your hands and don PPE if appropriate.
Introduce yourself to the parent(s) including your name and role.
Con
Ask about the ideas, concerns and expectations of the parent(s).
Determine the parent(s) prior knowledge of GORD.
Example
“ H e l l o , I’ m o n e o f t h e s t u d e n t d o c t o r s w o r k i n g w i t h t h e p r a c t i c e t o d a y . o k a y ? C a n I j u s t c o n
I’ v e b e e n a s k e d t o c o m e a n d s p e a k w i t h y o u , " W h a t a r e y o u r t h o u g h t s a b o u t w h a t' s b e e n g o i n g o n ?"
" W a s t h e r e a n y t h i n g y o u w e r e c o n c e r n e d a b o u t ?"
" W h a t w e r e y o u h o p i n g w e' d d o t o d a y ?"
" W h a t d o y o u k n o w a b o u t r e
i s t h a t

Reassurance

Begin by reassuring the parents that GORD is common in infants (40% are a
available to manage the condition. Explain that in most cases GORD will resolve spontaneously as the child grows.
Example
" F i r s t o f a l l t r y n o t t o w o r r y , r e
m e a n t i m e , w e h a v e s e v e r a l d i
"

Explanation

Explain the aetiology of GORD whilst avoiding the use of medical jargon wherever possible.
Children under 1 year of age
The oesophageal sphincter is not fully developed in children less than 1-year-old, allowing stomach contents to re
addition, because children at this age spend most of their time lying
the oesophagus. Children less than 1 also have a relatively short oesophagus meaning stomach contents can re
mouth more easily as there is less distance to travel. Re
with cerebral palsy or Down's syndrome.
Children older than 1 year of age
By the time infants are 1-year-old, GORD will have spontaneously resolved in approximately 90% of cases. Spontaneous
resolution occurs for several reasons including strengthing of the lower oesophageal sphincter, spending more time upright
and the transition to a diet of solid food.
Example
https\://app.geekymedics.com/osce-guides/counselling/paediatric-gord-explanation/ 1/311/13/24, 8\:19 PM Guide | Paediatric GORD explanation
“ W h e n y o u s w a l l o w , f o o d g o e s d o w n t h e f o o d p i p e , k n o w n a s t h e o e s o p h a gu s , i n t o t h e s t o m a c h . A t t h e b o t t o m o f t h e f o o d
p i p e , t h e r e i s a r i n g o f m u s c l e w h i c h o p e n s a n d c l o s e s t o l e t f o o d i n t o t h e s t o m a c h . I n y o u n g b a b i e s , t h i s m u s c l e i s n o t f u l l y
d e v e l o p e d a n d s o m e t i m e s m a y n o t c o m p l e t e l y c l o s e , w h i c h m e a n s m i l k c a n e a s i l y m o v e f r o m t h e s t o m a c h b a c k u p i n t o t h e
f o o d p i p e a n d m o u t h . B a b i e s a l s o s p e n d a l o t o f t i m e l y i n g
b a c k i n t o t h e f o o d p i p e a n d m o u t h .
”
“ B y t h e a g e o f 1 , r e
o f m u s c l e a b o v e t h e s t o m a c h b e c o m e s i n c r e a s i n gl y s t r o n g e r , p r e v e n t i n g t h e b a c k
o f 1 , c h i l d r e n a l s o t y p i c a l l y s p e n d m o r e t i m e u p r i g h t a n d e a t a d i e t t h a t c o n s i s t s o f s o l i d s , b o t h o f w h i c h r e d u c e t h e l i k e l i h o o d o f
r e
"

Management

Management of GORD in primary care

Infants with GORD typically experience frequent regurgitation and associated distress during these episodes.
Breastfed infants
Management of GORD in breastfed infants\:
Prescribe a 1-2 week trial of alginate therapy (e.g. Gaviscon ®
Infant) and if symptoms improve, periodically stop treatment
(e.g. every 2 weeks) to see if symptoms have improved and if it is possible to stop treatment completely.
Formula-fed infants
Management of GORD in formula-fed infants\:
Reduce the volume of feeds if they are excessive for the child's weight (a total feed volume of 150mL/kg body weight over
24 hours is recommended).
O
O
If the previous steps are unsuccessful, stop the thickener and o
after the trial continue with the treatment and suggest stopping the treatment at regular intervals to see if symptoms have
improved (with the aim of weaning of treatment).
Management of infants unresponsive to
If
Consider a 4 week trial of a proton pump inhibitor (e.g. omeprazole) to reduce stomach acid production.
If symptoms persist despite all of the above steps, refer to paediatrics.
Red
Some clinical features which indicate a need for paediatric referral include\:
Persistent faltering growth associated with regurgitation
Failure to respond to initial management options (as discussed below)
Feeding aversion and history of regurgitation
Iron de
No improvement in regurgitation after 1 year of age
Suspected aspiration pneumonia
Clinical features that indicate a need for same-day hospital admission\:
Haematemesis
Malaena
Dysphagia
Example
https\://app.geekymedics.com/osce-guides/counselling/paediatric-gord-explanation/ 2/311/13/24, 8\:19 PM Guide | Paediatric GORD explanation
“ T h e
t h a t y o u r b a b y g e t s a n a p p r o p r i a t e t o t a l a m o u n t o f m i l k o v e r a 2 4 h o u r p e r i o d .
"
" I f w e d o n' t s e e a n y i m p r o v e m e n t , w e c o u l d t r y a 1-2 w e e k t r i a l o f a d d i n g a t h i c k e n i n g a ge n t t o t h e f o r m u l a m i l k w h i c h m a k e s
t h e m i l k h e a v i e r a n d m o r e l i k e l y t o s t a y i n t h e s t o m a c h .
"
" I f w e s t i l l d o n' t s e e m u c h o f a n i m p r o v e m e n t , w e c o u l d c o n s i d e r a 1-2 w e e k t r i a l o f G a v i s c o n w h i c h i s a m e d i c a t i o n t h a t
n e u t r a l i s e s s t o m a c h a c i d .
"
" I f t h e G a v i s c o n m e d i c a t i o n d o e s n' t s e e m t o b e i m p r o v i n g s y m p t o m s , w e c o u l d c o n s i d e r a 4 w e e k t r i a l o f a m e d i c a t i o n t h a t
r e d u c e s t h e a m o u n t o f a c i d t h e s t o m a c h p r o d u c e s .
"
" I f d e s p i t e a l l o f t h e s e o p t i o n s , t e s t s a n d t r e a t m e n t .
"
t h e r e
" A l t h o u g h i n m o s t c a s e s r e
i f p r e s e n t , w o u l d r e q u i r e y o u r b a b y t o b e r e v i e w e d u r g e n t l y i n h o s p i t a l . T h e s e s y m p t o m s i n c l u d e y o u r b a b y' s s t o o l s t u r n i n g
b l a c k o r t h e p r e s e n c e o f b l o o d i n t h e i r v o m i t . I f e i t h e r o f t h e s e s y m p t o m s w e r e t o d e v e l o p , w e w o u l d n e e d t o a r r a n ge s a m e-d a y
a d m i s s i o n t o t h e h o s p i t a l .
"

Closing the consultation

Summarise the key points from the consultation\:
" S o , j u s t t o s u m m a r i s e , y o u r b a b y i s c u r r e n t l y s u
t h e b a c k
i n f a n t s b y t h e t i m e t h e y a r e 1- y e a r-o l d a n d i n t h e m e a n t i m e , w e h a v e s e v e r a l t r e a t m e n t s t h a t c a n i m p r o v e s y m p t o m s . I n s o m e
c a s e s , w e m a y n e e d t o r e f e r y o u r b a b y t o a p a e d i a t r i c i a n f o r f u r t h e r a s s e s s m e n t i f t h e t r e a t m e n t s d o n' t c o n t r o l t h e s y m p t o m s o r
i f t h e r e
b l o o d t o b e p r e s e n t i n t h e v o m i t a n d t h e s t o o l s t o b e c o m e v e r y b l a c k . T h i s c a n b e v e r y s e r i o u s a n d w o u l d r e q u i r e u r ge n t
h o s p i t a l a d m i s s i o n .
"
Check parental understanding and provide them with an opportunity to ask questions\:
" D o e s e v e r y t h i n g I' v e s a i d s o f a r m a k e s e n s e ?"
" D o y o u h a v e a n y q u e s t i o n s f o r m e ?"
Provide the parent(s) with details of resources where they can learn more (e.g. lea
Provide some safety net advice\:
" T h i s c o n d i t i o n i s v e r y c o m m o n , a n d a s y o u r b a b y i s s t i l l g r o w i n g w e l l i t i s n o t s o m e t h i n g t o b e
t o o c o n c e r n e d a b o u t . H o w e v e r i f t h i n gs d o n' t s e e m t o b e s e t t l i n g a n d y o u a r e c o n c e r n e d , p l e a s e d o n' t h e s i t a t e t o c a l l u s f o r
a n o t h e r r e v i e w .
"
Arrange follow-up\:
w e h a v e d i s c u s s e d . “ I w o u l d l i k e t o s e e y o u a g a i n i n a f e w w e e k s t o s e e h o w y o u a n d b a b y a r e d o i n g w i t h s o m e o f t h e c h a n ge s
I n t h e m e a n t i m e , i f y o u h a v e a n y c o n c e r n s o r f u r t h e r q u e s t i o n s , p l e a s e f e e l f r e e t o c o n t a c t m e o r t h e G P
p r a c t i c e .
”
Thank the parents for their time.
Dispose of PPE appropriately and wash your hands.

References

1. NICE CKS. Management of gastro-oesophageal reLINK].
Source\: geekymedics.com
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