![]() The impact of thickened feeds on other symptoms attributed to GERD, such as crying or fussiness, is unclear. ![]() They did decrease the daily number of episodes of vomiting and regurgitation, and weight gain improved in four studies. Thickened feeds did not improve acidity scores measured via pH-probe. Thickening agents included carob-bean gum (seven trials), cornstarch (three), rice starch (two), cereal (one), and soy fiber (one). Thickened feedsĮvidence for thickened feeds was summarized in a systematic review that included 14 randomized controlled trials (RCTs) comparing thickened with regular feeds. Non-pharmacological therapies to be considered for healthy infants with suspected GERD include thickened feeds, avoiding cow’s milk protein, and infant positioning. Non-pharmacological therapies for healthy infants with suspected GERD The management of severe disease or GERD associated with comorbidities is beyond the scope of this document. This practice point presents the evidence-base for management of symptoms attributed to GERD in healthy term infants younger than one year of age and discourages the over-prescription of medications in this population. The incorrect attribution of symptoms leads to frequent overtreatment of GERD by physicians. In the infant who is growing well, symptoms are unlikely to be improved by therapy aimed at GERD. Correlation between these symptoms and the acidity of esophageal secretions or endoscopic findings is weak. Crying, fussiness, and back arching with or without regurgitation may be normal behaviours or caused by other etiologies. This definition is problematic in infants because many symptoms attributed to GERD are non-specific. Gastroesophageal reflux disease (GERD) occurs when GER leads to symptoms that affect daily functioning or to complications. This can increase to 41% between 3 and 4 months of age, then subsequently decreases, becoming rare after 1 year of age. Regurgitation or vomiting following most feeds has been reported in 20% of healthy infants at 1 month of age. Gastroesophageal reflux (GER), which is the passage of gastric contents from the stomach to the esophagus, with or without regurgitation or vomiting, is common in healthy infants. Keywords: Children Gastroesophageal reflux (GER) Gastroesophageal reflux disease (GERD) H2 receptor antagonists (H2RAs) Infants Prokinetics Proton pump inhibitor (PPI) Anticipatory guidance regarding the natural resolution of reflux symptoms is recommended. Evidence for managing symptoms attributed to GERD in otherwise healthy term infants less than one year of age is presented, and the over-prescription of medications in this population is discouraged. Acid-suppressive therapy should not be routinely used for infants with GERD and is most likely to be useful in the context of symptoms that suggest erosive esophagitis. There is limited evidence for pharmacological management, including acid suppressive therapy or prokinetic agents, with the risks of such treatments often outweighing possible benefits due to significant safety and side effect concerns. Current recommendations to manage GERD include feeding modifications such as thickening feeds, or avoiding cow’s milk protein. ![]() ![]() This practice point reviews the evidence for medically recommended management of this common condition. Isabelle Chevalier MDCM, MSc, Carolyn E Beck MD, MSc, Marie-Joëlle Dore-Bergeron MD, Julia Orkin MD, MSc Canadian Paediatric Society, Acute Care Committee, Community Paediatrics CommitteeĬlinical symptoms attributed to gastro-esophageal reflux disease (GERD) in healthy term infants are non-specific and overlap with age-appropriate behaviours.
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