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GASTROESOPHAGEAL REFLUX DISEASE IN CHILDREN

Gastroesophageal reflux is categorized as a disease [gastroesophageal reflux disease (GERD)] when reflux is associated with warning signs &/or complications, & requires further evaluation.

It is more common in formula-fed infants than in purely breastfed infants.

There is increased incidence in infants at 4 months of age.

Patient Education

Patient/Parent/Guardian Education

Positional Modifications

  • Infants should be kept in an upright position during feeding
  • Infants & children should be fully awake when ingesting food
  • Semi-supine positioning for at least 2 hours after food ingestion may help reduce reflux-related respiratory events
  • Supine positioning during sleep is recommended

Obesity

  • Weight loss should be considered in older obese children
  • Studies have shown improvement in pH profiles in children who lost weight

Smoking & Alcohol

  • Smoking cessation & avoidance of alcohol intake is strongly encouraged adolescents
  • Exposure to secondhand smoke also increases irritability in infants & should be avoided

Lifestyle Modification

Dietary changes

  • May consider switching to milk formula that contains extensively hydrolyzed protein or amino acid-based formula instead of regular formulas
  • Maternal diet modification is encouraged for mothers of breastfeeding infants
    • Avoidance of egg & milk intake may be considered  
  • Thickeners (thickening agent, rice cereals) may be considered in healthy formula-fed infants but should be used with caution especially in preterm infants at increased risk for necrotizing enterocolitis
  • May try small, frequent feedings instead of one big meal while ensuring appropriate total daily amount of nutrition
  • Eating before bedtime should be avoided
  • Food that may trigger symptoms in adolescents (eg caffeine, carbonated drinks, chocolate, mint-containing food, spicy food) should be avoided
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