Gastro-oesophageal reflux Flashcards
What is gastro-oesophageal reflux (GORD)?
GORD is the passage of gastric contents into the oesophagus. It is considered physiological in infants when other symptoms are absent or not troublesome.
GORD = the commonest cause of vomiting in infancy
40% of infants regurgitate their feeds to a certain extent during the first 6 months of life
=> overlap with normal physiological process
=> common because the gastro-oesophageal sphincter is still developing
INFO CARD
How does GORD present in children?
As acid refluxes back up the oesophagus, babies commonly present with:
=> milky vomits / regurgitation after feeds
=> crying / irritability
=> apnoea
=> pneumonia
=> failure to thrive
=> anaemia
=> arching of the back (can sometimes be mistaken for seizures in extreme cases)
=> drawing up of the knees into chest
What are the risk factors for GORD in children?
- Preterm delivery
2. Neurological disorders
Diagnosis of GORD is made clinically.
How is GORD managed in children?
- Conservative management:
=> advice on keeping baby upright and burping after feeds
=> put cot on a slight incline for sleeping
=> infant sleeping on their back (also reduces risk of cot death)
=> ensure infant not overfed; consider smaller and more frequent feeds
=> trial of thickened formula
- Pharmacological management:
=> Alginate / antacid therapy i.e. Gaviscon - paste given after each breast feed
For term infants: dual dose sachets, 1 dose mixed with 15mls of water
=> PPI only recommended if additional symptoms i.e. unexplained feeding difficulties, distressed behaviour, faltering growth; PPI not recommended for isolated regurgitation
*Most resolve by 6-9 months ; if not consider fundoplication surgery
What are the complications of GORD in children?
Distress
Failure to thrive
Aspiration
Frequent otitis media
Older children - dental erosion may occur
*if there is severe complication i.e. failure to thrive, severe oesophagitis, apnoea, bleeding and medical treatment is ineffective => fundoplication should be considered (wraps the top part of stomach around the lower oesophagus to prevent GORD)
