Gastro-oesophageal reflux disease (GORD) is considered when gastro-oesophageal reflux causes troublesome symptoms and/or complications, such as failure to thrive, haematemesis, refusal to eat, sleeping problems, chronic respiratory disorders, oesophagitis, stricture, anaemia, apnoea or apparent life threatening episodes.¹
Like many illnesses in children, clinical manifestations of GORD may be protean—symptoms and signs are often non-specific in this age group. There is, furthermore, no gold-standard diagnostic test for GORD in children. Rather, a trial of nutritional management is recommended in infants while antacid medication is advised for early management in children.
- Demonstrating appropriate growth in infants using growth charts will reassure parents.
- Thickened feeds with anti-regurgitation formula may minimise the frequency of vomiting.
- While providing rapid symptom relief in the short term, long-term use of antacids (magnesium hydroxide / aluminium hydroxide) in infants is inadvisable as aluminium toxicity can cause renal disease.
- Histamine-2 receptor antagonists, such as ranitidine, can be considered in older children and adolescents for relieving GORD symptoms and for healing oesophagitis (though proton pump inhibitors (PPIs) are preferred).
- Trial dairy-product elimination in children with suspected cow’s milk protein allergy induced GORD – e.g. infant soy formula for 2 weeks in infants older than 6 months.
- Failing that, specialist referral to assess whether progression to extensively hydrolysed formula (eg. Pepti- Junior or Alfaré) is required in infants less than 6 months.
- Four-week proton-pump inhibitor (PPI) trial in older children and adolescents to improve symptoms.
- Of five PPIs available in Australia, omeprazole can be made in liquid form and lansoprazole comes in dispersible tablets.
- Long term safety data of PPIs in children are lacking.
- Of five PPIs available in Australia, omeprazole can be made in liquid form and lansoprazole comes in dispersible tablets.
- Consider eosinophilic oesophagitis in children with persistent GORD symptoms or where not responding to treatment. Refer these children to a paediatrician.¹
References
- Allen, Katie and Ho, Shaun S. C. “Gastro-oesophageal reflux in children: What’s the worry?” Aus Fam Phys 41(5), May 2012: 268-272.
- Jeaneth Indira Gonzalez Ayerbe, Bruno Hauser, Silvia Salvatore, and Yvan Vandenplas. Diagnosis and Management of Gastroesophageal Reflux Disease in Infants and Children: from Guidelines to Clinical Practice.
