Dyspepsia in children

Question 1

Features

Answer 1

Dyspepsia is an uncommon problem in children

can be caused by:

• drugs
• oesophageal disorders
• gastro-oesophageal reflux in particular.

It tends to be overdiagnosed and overtreated.

Question 2

Gastro-oesophageal reflux

Prognosis

Answer 2

Reflux gradually improves with time

• usually ceases soon after solids are introduced into the diet.

Most cases clear up completely by the age of 9 or 10 months, when the baby is sitting.

Severe cases tend to persist until 18 months.

Question 3

Investigations

Answer 3

These are not necessary in most cases,

• but in those with persistent problems or complications
• referral to a paediatrician is recommended.

Question 4

Management

Answer 4

Provide appropriate reassurance with parental education.

Changes in feeding practice and positioning will control most reflux.

Place infant on left side for sleeping

Prop up head of cot with bricks or boards to elevate it ~20–30 degrees).

Give smaller, more frequent feeds.

Thicken feeds (e.g. expressed milk) with Carobel, infant Gaviscon powder, cornflour or Karicare.

Medication not usually indicated but:

• if persistent and complications such as painful oesophagitis
• use antacids or
• a gastric acid reducing agent, e.g. ranitidine.