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Reflux

What is it and who does it affect?

Gastro-oesophageal reflux (GOR) is a common and normal physiological process in infants. Regurgitation occurs in up to 40–65% of healthy infants, typically peaks at 3–4 months of age, and, in most cases, resolves spontaneously by 12 months as oesophageal maturation and upright posture improve.1-3

Gastro-oesophageal reflux (GOR) vs gastro-oesophageal reflux disease (GORD)

GOR becomes gastro-oesophageal reflux disease (GORD) when reflux is associated with complications or persistent troublesome symptoms.

Red flags include poor weight gain, feeding refusal, marked irritability with feeding, haematemesis (vomiting of blood, from bright red to brown/black “coffee grounds”), dysphagia, apnoea, or recurrent respiratory symptoms.1,2 These infants require medical assessment.

In otherwise thriving infants with uncomplicated regurgitation, investigation and pharmacological therapy are not recommended. Acid suppression has limited evidence of benefit in this group and carries potential risks.1,2

Talking to parents about GOR

Current guidance emphasises reassurance, anticipatory guidance, and feeding review as first-line management.1-3

Key messages for parents include:

  • Reflux is very common and usually self-resolving.
  • Symptoms often improve after 6 months of age.
  • Most infants outgrow reflux by 12 months.

For breastfed infants, a skilled breastfeeding assessment is recommended where feeding difficulties are suspected.2

For formula-fed infants:

  • Review feeding volumes and technique.
  • Avoid overfeeding.
  • Consider smaller, more frequent feeds if intake is excessive.
  • If symptoms persist, a time-limited trial of thickened formula may be considered.1,3

Positional therapy is not recommended for routine management of infant reflux. Infants should be placed supine for sleep in accordance with safe sleeping guidelines.1-4

References

  1. Curien-Chotard M, Jantchou P. Natural history of gastroesophageal reflux in infancy: new data from a prospective cohort. BMC Pediatr. 2020;20:152. doi: 10.1186/s12887-020-02047-3
  2. Rosen R, Vandenplas Y, Singendonk M, Cabana M, DiLorenzo C, Gottrand F, et al. Pediatric gastroesophageal reflux clinical practice guidelines: Joint recommendations of NASPGHAN and ESPGHAN. J Pediatr Gastroenterol Nutr. 2018;66(3):516-554. doi:10.1097/MPG.0000000000001889
  3. National Institute for Health and Care Excellence (NICE). Gastro-oesophageal reflux disease in children and young people: diagnosis and management (NG1). 2015 (updated 2019). Available from: https://www.nice.org.uk/guidance/ng1
  4. Royal Children’s Hospital Melbourne. Clinical practice guideline: Gastro-oesophageal reflux disease in infants. Available from: https://www.rch.org.au/clinicalguide/guideline_index/Gastrooesophageal_reflux_disease_in_infants/