Key questions: GOR and GORD in infants

Key points

• Between 1% and 5% of infants have reflux, and reflux disease occurs in around 10% to 20% of these 
• The prognosis is good – these problems resolve in 95% of infants by about one year of age
• GORD may be complicated by anaemia, growth problems, respiratory problems, torticollis, pseudo-convulsions and haematemesis
• Differential diagnoses include cow’s milk protein allergy, UTIs, pyloric stenosis, raised intracranial pressure and intestinal obstruction
• Sodium alginate is a reasonable first line if there are no reflux-related complications 
• The next therapeutic step in infant reflux disease is usually antacid medication such as ranitidine or a PPI such as omeprazole in liquid form 
• De-escalation of treatment should be attempted every two months or so but is not usually successful until the child is between 10 and 12 months of age
• Severe reflux disease causing life-threatening apnoea or haematemesis or failure to thrive can be treated with nasojejunal feeding

Professor Mike Thomson is professor of paediatric gastroenterology at Sheffield Children’s Hospital and the Portland Hospital, Westminster, London

Q: What is the difference between gastro-oesophageal reflux (GOR) and gastro-oesophageal reflux disease (GORD) in infants?
A: Reflux disease is the term used when complications arise from reflux. These can include growth issues, anaemia, chest infections, obvious pain with inconsolable screaming and excessive vomiting.  

Q: There seems to be a huge symptom overlap between infant colic, cow’s milk protein allergy (CMPA) and GORD. How can they be distinguished in primary care?
A: Infant colic is a descriptive term and can be a manifestation of reflux, CMPA or even a maturational lack of the enzyme lactase, leading to a degree of lactose intolerance, which is separate from CMPA. These problems are difficult to distinguish and often CMPA and reflux coexist, as CMPA can precipitate reflux disease in infants. 

Fortunately both conditions resolve between nine and 15 months of age. 

A family history of atopy might point to CMPA but often it is a case of trying either hypoallergenic milk (or maternal exclusion of dairy and soya if breast feeding) or an antacid. If either approach fails the other is followed after a 14-day period.

Click here to read the full article and download your certificate logging 2 CPD hours towards revalidation