Reflux

What is it and who does it affect?

It is important to remember that gastro-oesophageal reflux (GOR) is well accepted as being both a common and normal physiological process in infants.^1-4  It has been reported that frequent regurgitation of feeds is also common, occurring in about 41%-67% of infants and peaks at about 3-4 months of age.^5,6

Differences between gastro-oesophageal reflux (GOR) and gastro-oesophageal reflux disease (GORD)

It is equally important to remember that GOR sometimes is accompanied by what are usually referred to as bothersome or troublesome symptoms such as recurrent vomiting, irritability, respiratory symptoms, feeding refusal, failure to thrive, dysphagia, dystonic neck posturing and haematemesis.  This then is referred to as gastro-oesophageal reflux disease (GORD) and it is usually recommended that the infant should receive medical advice and/or treatment.⁷

Talking to parents about GOR

However, in the case of GOR international guidelines suggest that re-assurance and education that should be provided to parents or carers of such infants and medical intervention is not required.  The United Kingdom’s 2015 NICE clinical guidelines provide key messages that can be conveyed to families.⁷ These are that as previously stated GOR is very common affecting at least 40% of infants.  Also, GOR usually begins before the infant is 8 weeks old, may be frequent with 5% of those affected have 6 or more episodes each day. Finally, GOR usually becomes less frequent with time resolving in 90% of affected infants before they are 1 year old.

Whilst national and international guidelines state clearly that GOR is a normal physiological event and does not require further investigation or treatment ² some suggest that “lifestyle and/or nutritional changes” in the infant may be beneficial.⁷ In breastfed infants with it has been suggested that a person with appropriate expertise and training carries out a breastfeeding assessment.⁷

In formula-fed infants following a review of feeding history, such changes suggested include reducing feed volumes only if excessive for the infant’s weight, then offering a trial of smaller more frequent feeds (while maintaining an appropriate total daily amount of milk) and then offering a trial of a thickened formula.⁷

Guidelines and recommendations that have been distilled from the international literature can also often be found via Royal Children’s Hospital websites for example.⁸

1. Curien-Chotard M, Jantchou P. Natural history of gastroesophageal reflux in infancy: new data from a prospective cohort. BMC Pedatr. 2020; 20:152.
2. Rosen R, Vandenplas Y, Singendonk M, et al. Pediatric gastroespphageal reflux clinical practice guidelines: Joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr. 2018: 66. 3 516-554.
3. Vandenplas Y, Rudolph CD, Di Lorenzo C, et al, Pediatric gastroesophageal reflux clinical practice guidelines: Joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr .2009;49:498-547.
4. Vandenplas Y, Goyvaerts H, Helven R, Sacre L Gastroesophagael reflux, as measured by 24-hour pH monitoring, in 509 healthy infants screened for risk of sudden infant death syndrome. Pediatrics. 1991;88:834-840.
5. Nelson SP, Chen EH, Syniar GM, Christoffel KK. Prevalence of symptoms of gastroesophageal reflux during infancy. Arch Pediatr Adolesc Med. 1997; 151: 569-572.
6. Martin AJ, Pratt N, Kennedy JD, et al, Natural history and familial relationships of infant spilling to 9 years of age. Pediatrics 2002;109:1061-1067
7. Davies I, Burman-Roy, Murphy MS. Gastro-oesophageal reflux disease in children: NICE guidance. BMJ. 2015; 350:g7703
8. https://www.rch.org.au/clinicalguide/guideline_index/Gastrooesophageal_reflux_disease_in_infants/