Gastro-oesophageal reflux disease (GORD) – kids

• GOR is the passage of gastric contents into the oesophagus, often resulting in vomiting or ‘posseting’. 
• GOR is common affecting at least 40% of infants, usually beginning before 8 weeks of age, peaks at 4 months and
• resolves by 1 year in the majority of cases. 
• There is no relationship between an infant with GOR and crying or irritability.
• There is also no evidence that ‘silent reflux’ exists

Acid suppression medication use in infants with reflux

• The use of PPIs and H2RAs to manage infants with GOR has increased.
• These medications have been shown to have no benefit in improving symptoms in infant GOR.
• In contrast, studies have shown that PPIs and H2RAs can cause harm, including:

• 3.6 times more likely to develop acute gastroenteritis
• 6.4 times more likely to develop community-acquired pneumonia
• 1.6 times more likely to have a fracture (with a higher dose, starting earlier (under 6 months old), and
• a longer duration all individually linked to increased fracture risk)

• 5.24 times more likely to contract Clostridium difficile infection
• Vitamin B12 deficiency, hypomagnesaemia and rebound hyperacidity after discontinuation

• If parents are requesting PPIs or H2RAs it is important to explain the harms associated with these medications
• and that there are no proven benefits in infants with reflux.

• The prescription of PPIs and H2RAs is only indicated in infants with Gastro-oesophageal reflux disease (GORD). 
• Only a small percentage of infants have GORD, characterised by frequent vomiting AND additional symptoms such as:
  1. Choking, coughing or wheezing during feeds
  2. Vomiting up blood
  3. Distress during feeds or refusal to feed
  4. Poor weight gain or weight loss

How to know when it’s GORD or something else:

• In some cases, infants presenting with GORD-like symptoms may actually have a Cow’s Milk Protein Allergy
• (CMPA) or lactose intolerance
• Below is a useful flowchart to help guide your assessment process in determining if a crying/unsettled infant
• has
  • GOR
  • GORD
  • CMPA
  • lactose intolerance

AWESOME LINK: https://www.rch.org.au/uploadedFiles/Main/Content/hsru/Parent_Managing%20Unsettled%20Babies_public.pdf