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Reflux GOR fact sheet [Kids health info for parents website]
Gastrooesophageal reflux (GOR) is the passage of gastric contents into the oesophagus. It is a physiological process that occurs several times a day in healthy persons. Its clinical presentation of vomiting or regurgitation is very common
in infants and in the majority of cases self-resolving and does not need treatment. It may be associated with irritability but only very few "crying babies" will have significant GOR as the cause for their irritability. Reassurance of the parents is
important (see parent information).
"Silent" reflux as GOR without vomiting/regurgitation is a controversial entity; certainly significant acid reflux (pH probe-proven) is always associated with vomiting
Gastrooesophageal reflux disease (GORD) is GOR leading to complications. It is rare but more frequent in children with cerebral palsy, Down syndrome, cystic fibrosis and upper gastrointestinal malformations (tracheooesophageal fistula, hiatus
hernia, pyloric stenosis).
The complications of GOR are
The symptoms of GORD are vomiting with
GOR does not cause Sudden Infant Death Syndrome (SIDS). However, GOR can be associated with an Apparent Life Threatening Event (ALTE).
Investigations and treatment are normally not necessary, as GOR is a benign and self-resolving condition. Reassurance of parents is important (see parent information).
If symptoms of GORD are present (see above) the child should be referred to General Medical Clinic within 1 week.
All investigations for GOR (barium, scintigraphy, endoscopy and pH probe) have considerable limitations and should only be considered on an individual base after the patient has been assessed in General Medical Clinic.
Don't encourage parents to change formulas.
Never change a breastfed child to formula.
As long as there is good weight gain and there are no symptoms of GORD, the most common cause will be a coincidence of a crying baby with simple GOR.
As mentioned above, GOR does normally not require any treatment. However, GOR can be the cause of considerable parental distress. Measures that may be considered include:
There is no evidence that the following measures make any difference in GOR but they also can be considered:
Both histamine-2 receptor antagonists (HRA, eg Ranitidine) and proton pump inhibitors (PPI, eg Omeprazole) produce relief of symptoms and mucosal healing. PPI are superior and therefore the recommended therapy is:
Under 10 kg: 5 mg once daily
10-20 kg: 10 mg once daily (max 20 mg/day)
Over 20 kg: 20 mg once daily (max 40 mg/day)
Less effective than HRAs and PPIs and the metal contained in antacids (magnesium or aluminium hydroxide) and surface agents (sucralfate gel, alginates) make them unsuited for use in infants.
Due to concerns about potential serious cardiac arrhythmias in patients receiving cisapride, prokinetics are no longer recommended for treatment of GOR.
Failure of medical therapy or recurrent respiratory symptoms (aspiration).
Nissen fundoplication is the most widely used of the surgical procedures.
Parent Information Sheet (HTML version)