GI - Gastro-Oesophageal Reflux Disease (GORD)

Question 1

What is Gastro-Oesophageal Reflux?

Answer 1

Contents from the stomach reflux through the LOS into the Oesophagus, Throat and Mouth.

Question 2

Aetiology of Gastro-Oesophageal Reflux in Babies.

Answer 2

Immaturity of LOS allows reflux - normal, provided there is normal growth and no other concerning features.

Question 3

Prognosis of ‘Healthy’ Gastro-Oesophageal Reflux.

Answer 3

90% of infants stop having reflux by 1 year.

Question 4

Give 8 causes of vomiting in children.

Answer 4

1. Overfeeding.
2. Gastro-Oesophageal Reflux.
3. Pyloric Stenosis.
4. Gastritis/Gastroenteritis.
5. Appendicits.
6. Infections e.g. UTI, Tonsillitis, Meningitis.
7. Intestinal Obstruction.
8. Bulimia.

Question 5

Epidemiology of Gastro-Oesophageal Reflux (3).

Answer 5

1. Commonest cause of vomiting in infancy.
2. 40% of infants regurgitate feeds to a certain extent.
3. Develops typically before 8 weeks.

Question 6

Risk Factors of Gastro-Oesophageal Reflux (2).

Answer 6

1. Pre-term Delivery.

2. Neurological Disorders.

Question 7

Red Flags of Dehydration (4).

Answer 7

1. Drowsy.
2. Floppy.
3. Dry Mucous Membranes.
4. Sunken Eyes.

Question 8

What is Posseting?

Answer 8

Vomiting simple small volumes of milky feeds (extremely common after feeds). Larger volume regurgitation may represent GORD.

Question 9

What is Sandifer’s Syndrome?

Answer 9

A rare condition that causes brief episodes of abnormal movements associated with GOR in infants - neurologically normal but acute dystonic reactions e.g. torticollis.

Question 10

Prognosis of Sandifer’s Syndrome.

Answer 10

Tends to resolve as the reflux is treated or improved.

Question 11

Red Flags of Problematic Reflux (6).

Answer 11

1. Chronic Cough.
2. Hoarse Cry.
3. Distress, Crying, Unsettled After Feed.
4. Reluctance to Feed.
5. Pneumonia.
6. Poor Weight Gain.

Question 12

Management of Gastro-Oesophageal Reflux in Kids (5).

Answer 12

1. Explanation, Reassurance and Practical Advice.
2. Gaviscon mixed with feeds.
3. Thickened Milk/Formula.
4. Ranitidine.
5. Omeprazole (if Ranitidine is inadequate).

Question 13

Give 4 practical advice tips to parents.

Answer 13

1. Small frequent meals.
2. Encourage burping regularly to help milk settle.
3. No overfeeding.
4. Keep baby upright after feeding (30 Degrees Head Up).

Question 14

Why should infants sleep on their backs?

Answer 14

Reduce risk of cot death.

Question 15

Give 4 examples of thickened milk or formula alternatives.

Answer 15

Specific anti-reflux formulas e.g. :

1. Rice-Starch.
2. Corn-Starch.
3. Locust Bean Gum.
4. Carob Bean Gum.

Question 16

Give 5 complications of GOR in kids.

Answer 16

1. Distress.
2. Failure to Thrive.
3. Aspiration.
4. Frequent Otitis Media.
5. Dental Erosion (in Older Kids).