Introduction

Gastro-oesophageal reflux is the commonest cause of vomiting in infancy. Around 40% of infants regurgitate their feeds to a certain extent so there is a degree of overlap with normal physiological processes.

Epidemiology

  • Incidence: 50.00 cases per 100,000 person-years
  • Most commonly see in infants
  • Sex ratio: 1:1
Condition Relative
incidence
Infantile colic3.60
Gastro-oesophageal reflux in children1
Pyloric stenosis0.08
<1 1-5 6+ 16+ 30+ 40+ 50+ 60+ 70+ 80+

Aetiology

Risk factors
  • preterm delivery
  • neurological disorders

Clinical features

Features
  • typically develops before 8 weeks
  • vomiting/regurgitation following feeds

Management

Management (partly based on the 2015 NICE guidelines)
  • advise regarding position during feeds - 30 degree head-up
  • infants should sleep on their backs as per standard guidance to reduce the risk of cot death
  • ensure infant is not being overfed (as per their weight) and consider a trial of smaller and more frequent feeds
  • a trial of thickened formula (for example, containing rice starch, cornstarch, locust bean gum or carob bean gum)
  • a trial of alginate therapy e.g. Gaviscon. Alginates should not be used at the same time as thickening agents
  • NICE do not recommend a proton pump inhibitor (PPI) or H2 receptor antagonists (H2RA), to treat overt regurgitation in infants and children occurring as an isolated symptom. A trial of one of these agents should be considered if 1 or more of the following apply:
    • unexplained feeding difficulties (for example, refusing feeds, gagging or choking)
    • distressed behaviour
    • faltering growth
  • prokinetic agents e.g. metoclopramide should only be used with specialist advice

Complications

Complications
  • distress
  • failure to thrive
  • aspiration
  • frequent otitis media
  • in older children dental erosion may occur