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Unsettled or crying babies
Gastro-oesophageal reflux (GOR) is the passage of gastric contents into the oesophagus, often with effortless vomiting, or 'possets'. It is a physiological process that occurs several times a day in healthy infants.
There is insufficient evidence to support the diagnosis or management of "silent reflux"
Gastro-oesophageal reflux disease is when GOR causes vomiting with:
milk protein allergy (CMPA) can present with similar symptoms to GORD.
Investigations for GORD (such as barium contrast radiography, pH probe, endoscopy) are rarely necessary, and are not diagnostic. Investigations should only be considered on an individual basis after the patient has been assessed by a paediatrician.
Simple GOR can cause considerable parental distress, and requires reassurance, support and anticipatory guidance. General measures may minimize symptoms.
Acid suppressant therapy may be indicated in specific patients with GORD (see flow chart). When commenced, it should be instituted as a four week trial. Omeprazole, a proton pump inhibitor (PPI), is the recommended agent:
Studies have indicated that PPI therapy may lead to an increased risk of:
There is no evidence to support empiric use of acid-suppressant therapy as a diagnostic trial for irritable infants
It is important to review ongoing therapy and cease at 4 weeks if no benefit
Surface agents such as sodium alginate (Gaviscon infant ®) increases viscosity of gastric contents and can reduce episodes of visible regurgitation. There is little information available on efficacy and long-term use in infants is not recommended
Surgical approaches (e.g. fundoplication) are reserved for children who have intractable GORD symptoms unresponsive to medical therapy or with significant complications
Child requiring care beyond the comfort level of the hospital
For emergency advice and paediatric or
neonatal ICU transfers, see Retrieval
REducing MEDications in Infants (REMEDI)
Last updated October, 2019