Gastro - Oesophageal Reflux Flashcards
Why does reflux occur in babies?
Immaturity of the lower oesophageal sphincter
Stomach content refluxes into oesophagus
Normal for baby to reflux, no issues if normal development
90% stop by 1 year
How does reflux present?
Normal after larger feeds
Problematic reflux:
- Chronic cough
- Hoarse cry
- Distress, crying or unsettled after feeding
- Reluctance to feed
- Pneumonia
- Poor weight gain
What symptoms do children over 1 experience with reflux?
Similar to adult symptoms
Heartburn
Acid regurgitation
Retrosternal or epigastric pain
Bloating
Nocturnal cough
What are some possible causes of vomiting?
Overfeeding
Gastro-oesophageal reflux
Pyrloric stenosis
Gastritis or gastroenteritis
Appendicitis
UTI, tonsillitis or meningitis
Intestinal obstruction
What red flags indicate pyloric stenosis?
Not keeping down any feed
Projectile or forceful vomiting
What are the red flags of intestinal obstruction?
Not keeping down any feed
Projectile or forceful vomiting
Bile stained vomit
Abdominal distension
What red flags can indicate meningitis or raised ICP?
Reduced consciousness
Bulging fontanelle
Neurological signs
What type of symptoms indicate aspiration and infection?
Respiratory symptoms
What can indicate a cows milk protein allergy?
Blood in stools
Rash
Angioedema
(other allergy signs)
How is reflux managed?
Simple cases
Provide explanation, reassurance and practical advice
- Small frequent meals
- Burping regularly to help milk settle
- Not over-feeding
- Keep baby upright after feeding
How is problematic reflux managed?
Gaviscon mixed with feeds
Thickened milk or formula
PPIs e.g. omeprazole
What is the last-line treatment for reflux and what investigation is done for it?
Surgical fundoplication if very severe
Barium meal and endoscopy
What is Sandifer’s syndrome?
Rare condition causing short episodes of abnormal movements associated with reflux in infants
What are the key features of Sandifer’s syndrome?
Torticollis
Dystonia
- Abnormal muscle contractions causing twisting movements e.g. arching of the back
How is Sandifer’s syndrome managed?
Specialist referral for assessment
Tends to resolve as reflux is treated or improves
