Gastroesophageal reflux is a normal physiological activity, and gastroesophageal reflux disease (GORD) occurs when this process causes severe symptoms requiring medical treatment or has associated complications. In infants and children, distinguishing between this GERD and GORD is particularly difficult due to a variety of underlying symptoms and the lack of a simple, reliable, and widely available diagnostic test. Thus, the real burden of this problem is difficult to quantify and clinical practice is extremely variable.
Children affected by this disorder include preterm and term infants, as well as infants and children, those with known risk factors for repairing diaphragmatic hernias and other congenital malformations, or severe neurological disorders. The children’s group may have complex comorbidities and there are important differences in pathophysiology. This article summarizes the NICE (National
Institute for Health and Care
Excellence) on how to identify, diagnose, and manage GERD in infants, children, and adolescents.
Gastroesophageal reflux disease diagnosis and research
▲ Reflux during feeding as a common and normal occurrence in infants, namely.
–caused by GERD in infancy and childhood, a normal physiological process.
–Usually does not require any examination or treatment.
– Symptoms can be controlled with some suggestions to reassure parents.
▲It is important to note that in a small percentage of infants and children, GERD may be associated with signs of distress or lead to some sort of complication that requires clinical management. This is referred to as GERD.
▲ Recommendations regarding GERD are.
– The symptoms are common (affecting at least 40% of infants)
–usually present before 8 weeks of age in infants and children
–may be frequent (≥6 times per day in 5% of affected children)
–Symptoms become less frequent with time (resolves in 90% of affected infants by 1 year of age)
–Usually no further testing or treatment is needed
▲When parents and caregivers are concerned about reflux, they need to be reminded to bring their child back for follow-up if.
–reflux persists and rebounds
—There is bile staining (green or yellow-green), vomiting or vomiting of blood (vomiting with blood)
–New problems, such as obvious signs of distress, feeding difficulties, or slow growth
– persistent and frequent reflux despite being older than 1 year
In infants, children and adolescents with vomiting or reflux, look for “red flag” symptoms, which may indicate the presence of vomiting or reflux.
flag” symptoms, which may suggest some disorder other than GERD. Check or refer, using clinical judgment.
An infant or child does not need to be regularly examined or treated for GERD if he or she does not present with the following significant reflux symptoms.
– Unexplained feeding difficulties (e.g., refusal to eat, vomiting, or choking)
–distressing behavior
–Slow growth
–Chronic cough
–Heartness of voice
–Alone episodes of pneumonia
▲In infants, children, and young adults, identify the following GERD complications when possible.
–Reflux esophagitis
–Recurrent aspiration pneumonia
–Frequent otitis media (e.g., >3 episodes in 6 months)
–Dental erosion in the presence of neurological deficits, especially cerebral palsy
▲In children and adolescents, the following GERD symptoms should be identified when possible.
–heartburn
–posterior sternal pain
–epigastric pain
▲Please note that GERD is more common in children and adolescents with asthma, but asthma has not been shown to cause or exacerbate GERD.
▲ Note that some symptoms of non–IgE-mediated milk protein allergy are similar to GORD symptoms, especially in infants and children with allergic symptoms, signs, or family history (or a combination of them). If non–IgE-mediated milk proteins are suspected, please consult the NICE food allergy guidelines for children and young people.
▲ When deciding whether to test or treat, consider the following factors associated with increased prevalence of GORD.
–premature birth
–obesity
–Hiatal hernia
–History of congenital diaphragmatic hernia (repaired)
-History of congenital esophageal atresia (repaired)
–Nerve disorders
▲ For children and young people who are obese and have heartburn or acid reflux, it is recommended that they and their parents or carers implement weight loss and weight control, which may improve symptoms (see also NICE obesity guideline).
Guideline details 》》》》2014NICE clinical guideline: Identification assessment and management of overweight and obese children, young people and adults
▲Infants and children with continuum posterior arch, or Sandifer’s syndrome features, need to be assessed by a specialist.
Gastroesophageal reflux rarely causes episodes of apnea or significantly life-threatening events, but if reflux is suspected as a possible factor after general pediatric evaluation, referral to a specialist needs to be considered.
▲In infants or children, upper gastrointestinal angiography cannot be offered to diagnose or assess the severity of GORD. This can be used to detect unexplained bile staining (very urgent in infants and children) or dysphagia.
▲In infants and children <2 months of age with progressive worsening of feeding or vomiting, a further same-day emergency specialist hospital evaluation needs to be arranged to check them for hypertrophic pyloric stenosis.
▲In infants and children with reflux, the possibility of urinary tract infection needs to be checked if there are signs of.
–slow growth
– Delayed onset of reflux (after 8 weeks)
–frequent reflux and significant distress (Note: there is limited evidence for “significant distress”, no objective or widely accepted clinical definition, and infants and children cannot adequately express their sensory emotions. For the purposes of this guideline, marked distress involves outward displays of pain or unpleasant manifestations, and a range can be developed with appropriate training based on a comprehensive assessment that includes a fully detailed narrative analysis provided by parents and caregivers.)