Gastro Medicine - Gastro-oesophageal reflux in children Flashcards
1
Q
Gastro-oesophageal reflux is the commonest cause of vomiting in infancy, What percentage of children re-gurgitate their food?
A
Around 40% of infants regurgitate their feeds to a certain extent so there is a degree of overlap with normal physiological processes.
2
Q
What are the risk factors and features?
A
Risk factors
- preterm delivery
- neurological disorders
Features
- typically develops before 8 weeks
- vomiting/regurgitation following feeds
3
Q
Management (partly based on the 2015 NICE guidelines)?
A
- 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
4
Q
Management (partly based on the 2015 NICE guidelines)?
A
- 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
5
Q
What are the complications of Gastro-oesophageal reflux in children?
A
Complications
- Distress
- Failure to thrive
- Aspiration
- Frequent otitis media
- In older children dental erosion may occur
If there are severe complications (e.g. failure to thrive) and medical treatment is ineffective then fundoplication may be considered
