11/14/24, 10\:52 AM Paediatric Gastro-oesophageal Reflux Disease

Paediatric Gastro-oesophageal Re

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Gastro-oesophageal re
not troublesome.
Gastro-oesophageal re
infants, usually resolves by age 1.
Aetiology\: no singular cause; anatomical (short/narrow oesophagus, sphincter above diaphragm) and physiological (weak
lower oesophageal sphincter) factors.
Risk factors\: prematurity, congenital diaphragmatic hernia, oesophageal atresia, hiatus hernia, neurodisability (e.g. cerebral
palsy), parental history of heartburn.
Symptoms (\<1 year)\: feeding >30 mins, distressed behaviour during feeding, hoarseness, chronic cough, faltering growth.
Symptoms (>1 year)\: retrosternal pain, epigastric pain.
Red
distension/pain.
Examination\: basic observations, head circumference, respiratory examination (single pneumonia episode), abdominal
examination (usually normal).
Di
infection.
Investigations\: clinical diagnosis, feeding assessment by health visitor, exclude red
Management\:
Explain diagnosis to parents/carers.
Breastfed infants\: 1-2 weeks of alginate therapy (e.g. Gaviscon infant).
Formula-fed infants\: stepwise approach - reduce feed volume, keep upright after feeding, raise head of cot, trial
smaller/more frequent feeds, trial Gaviscon, trial PPI (e.g. omeprazole) or H2 antagonist (e.g. ranitidine).
Refer to paediatrician for red
Complications\: re
in 6 months).
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Introduction

Gastro-oesophageal re
when asymptomatic or not troublesome to the patient.
1
Gastro-oesophageal re
(e.g. discomfort or pain) or complications.
1
Regurgitation of feeds is common and occurs in at least 40% of infants. 2
resolve before they turn one year old.
2
It usually begins before 8 weeks old and will
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Aetiology

There is no singular cause for GORD. However, patients may be more likely to have the condition due to anatomical and
physiological di
3
Anatomical conditions may include where the oesophagus is shorter or narrower than average or if the lower oesophageal
sphincter is slightly above the diaphragm rather than below it.
The most common physiological cause involves the natural weakness of the lower oesophageal sphincter, allowing the
passage of stomach contents involuntarily. It typically resolves by 1-year-old as the sphincter naturally strengthens.

Risk factors

Risk factors for GORD in infants include\:
Prematurity\: the incidence of GORD is even higher in preterm infants, particularly if the infant has a feeding tube
History of congenital diaphragmatic hernia or oesophageal atresia
Hiatus hernia
Neurodisability (e.g. cerebral palsy)
Parental history of heartburn or acid regurgitation

Clinical features

History

alternative diagnosis.
3
GORD is a clinical diagnosis. It is essential to distinguish between typical symptoms and red
Typical symptoms of GORD if the child is \<1 include\:
Time taken to feed >30 minutes
Distressed behaviour during meal times (e.g. crying while feeding or refusing to feed)
Hoarseness and/or chronic cough
Faltering growth
Typical symptoms of GORD if the child is >1 include\:
Retrosternal pain
Epigastric pain
Red
Red
Persistent symptoms despite management of GORD or age above >1
Non-bilious, projective vomiting in children 2- 6 weeks\: suggests hypertrophic pyloric stenosis
Abdominal distension/pain\: may indicate intestinal obstruction, tinkling bowel sounds may be heard when
auscultating.
For more information, see the Geeky Medics guide to paediatric history taking.

Clinical examination

In the context of suspected GORD, it is important to perform a thorough examination of the child, including\:
Basic observations (vital signs)\: in particular, the child’s temperature will help to exclude other acute di
infection).
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Head circumference\: Using a Lasso-O, the child's head circumference should be measured and plotted to help exclude
other worrying patterns (e.g. faltering growth)
Respiratory examination\: respiratory symptoms or signs. Children may have a single episode of pneumonia with GORD,
but recurrent episodes should prompt further investigations.
Abdominal examination\: usually normal. If any positive examination
considered.

Di

Di
Anatomical disorders\: cleft lip/palate and ankyloglossia (tongue tie)
Gastrointestinal disorders\: cow’s milk protein allergy (CMPA), coeliac disease and lactose intolerance.
If there is a sudden change in feeding habits, an acute cause (e.g. infection) should be excluded.

Investigations

GORD is a clinical diagnosis and does not usually require further investigations.
1
If the child is breastfed, a feeding assessment by a health visitor is bene
techniques and attachment.
A feeding history, exploring the history and examination above, should be taken to exclude red
specialist assessment.
Children should be charted on a growth chart to exclude other causes of faltering growth.

Management

It is important to explain the diagnosis of GORD to the parents or carers of the child.
Subsequent feed alterations will depend on whether they are breastfed or formula-fed.
If the child is breastfed, alginate therapy (e.g. Gaviscon infant) can be used for 1-2 weeks.
If the child is formula-fed, then a stepwise approach is used\:
Reduce the volume of feed if excessive for the child’s weight
Keep infant upright after feeding for up to 30 minutes
A 1-2 week trial of smaller, more frequent feeds
A 1-2 week trial of adding Gaviscon to the usual feed
A 4-week trial of a proton pump inhibitor (e.g. omeprazole) or a histamine-2 receptor antagonist (e.g. ranitidine)
Positional management (i.e. head elevation or left lateral positioning) should not be used in a sleeping child.
1
Referral to a paediatrician should be made if there are any red-
old.

Complications

Most children who have GORD will not develop complications. However, complications may include\:
Re
Recurrent aspiration pneumonia
Recurrent acute otitis media (more than three episodes in 6 months)
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References

NICE CKS. Management of gastro-oesophageal reLINK]
BMJ Best Practice (2022). Disorders of infant feeding. Available from\: [LINK]
Dogra H, Bhavini L, Sirisena D. Paediatric Gastric-Oesophageal Re
2011;4(2)\:a412.

Reviewer

Dr Shakirat Balogun
Paediatric Registrar

Related notes

Attention De
Autism Spectrum Disorder (ASD)
Biliary Atresia
Bronchiolitis
Cerebral Palsy

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Contents

Introduction
Aetiology
Risk factors
Clinical features
Di
Investigations
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