Reflux

Question 1

Px

Answer 1

Vomit after feed
Colic- crying esp while feed, knees up, neck posture
Hoarseness or chronic cough
Pneumonia
Unexpl feeding diffic
Fail hrive

Question 2

Diffs

Answer 2

Normal positing, maybe overfeed (should be 150ml/kg/day)
GORD- haematemesis, recurr chest infec from asp, fail thrive, pain eg back arching
Cow mil prot intol- more comm than lactose in babies. Test by remove from diet, incl mums diet if breast feeding. Skin prick immed IgE hypersens.

Question 3

Mx

Answer 3

Observe feeds, HV inv
Trial GOR advice eg smaller regular feeds, thickened feeds, tilt bed
Sachet infant gaviscon
Trial CMP free
Ranitidine or PPI if sure is reflux (ie pos 24hr pH test or v strong hx) and above not worked. 4 wk trial initially.

Question 4

Why GORD risk in under 1s

Answer 4

Delayed gastric emptying

Short narrow oesophagus

Question 5

GORD RFs

Answer 5

Preterm
Parent hx
Obesity
Hiatus hernia
Congenital diaph hernia hx
Congenital oes atresia hx
Neurodisability

Question 6

Complics

Answer 6

Oesophagitis
Asp pneum
Recurr acute OM
Dental erosion