Gastroesophageal reflux

Question 1

Number of infants with GOR at 4 months, 6-7 months and 12 months

Answer 1

At 4 months->67%
At 6-7 months 20%
At 12 months 5%

Question 2

What is considered GORD

Answer 2

GOR with complications

Question 3

When is GORD more common, what conditions (4)

Answer 3

Cerebral palsy
Down’s syndrome
Cystic fibrosis
Upper GIT malformations->TOF, hiatus hernia, pyloric stenosis

Question 4

Complications of GOR in children

Answer 4

Esophaitis
Failure to thrive
Aspiration

Question 5

Symptoms of GORD

Answer 5

Irritability
Refusal to feed
Weight loss
Hematemesis
Chronic cough, wheeze
Apneas

Question 6

When are investigations indicated

Answer 6

Symptoms of GORD

Question 7

Management: general, 1. recurrent vomiting with symptoms of GORD, 2. recurrent vomiting with irritability, simple recurrent vomiting

Answer 7

Do not change formulas
Do not encourage to stop breastfeeding

1. Exclude other causes. Refer to general medical clinic for Ix.
2. If good weight, no GORD S->coincidental distress + vomiting. Exclude other causes. General measures. Symptom diary, GMC in 1-2 weeks, suppressant therapy-> if +concerns.
3. Exclude other causes. Reassure. General measures. Info sheet for parents.

General measures->
Prone position after feeding.
Milk thickening (rice cereal)

No evidence, but may try:
-ve smoke exposure
Avoid Overfeeding
Aerophagia- avoid
Smaller more frequent meals

Question 8

Suppressant therapy if indicated

Answer 8

Omeprazole:
Under 10 kg: 5 mg once daily
10-20 kg: 10 mg once daily (max 20 mg/day)
Over 20 kg: 20 mg once daily (max 40 mg/day)