Makindo Medical Notes

Related Subjects: |Encopresis in Children |Enuresis/Bedwetting in Children |Acute Glomerulonephritis in Children |Nephrotic Syndrome in Children |Acute Appendicitis in Children |Gastro-oesophageal reflux in Children |Intussusception in Children |Panayiotopoulos Syndrome in Children |Reflex anoxic attacks in Children

Introduction

• GORD (Gastro-oesophageal reflux disease) and oesophagitis in children present with a variety of symptoms, often after feeding.
• Common symptoms include regurgitation, distress after feeds, apnoea, pneumonia, failure to thrive, and anaemia.

Diagnosis

• Clinical Diagnosis: GORD is typically diagnosed based on the history and presentation of symptoms. Tests are not always necessary.
• Endoscopy: May be required if eosinophilic oesophagitis is suspected.
• Oesophageal pH Probe: Rarely carried out but can be used if there is concern about acid reflux severity.
• Ultrasound: Not particularly useful for diagnosing GORD in infants.

Treatment

• Reassurance: Many cases resolve naturally over time, so parents should be reassured, especially for mild cases.
• Avoid Over-feeding: A common cause of GORD in infants. Reducing the volume of feeds can help reduce reflux.
• Medications: In more severe cases, medications may be needed, such as:
  • Antacids: Over-the-counter medications like sodium/magnesium alginate (e.g., Infant Gaviscon®). For term infants, one sachet mixed with 15mL of cooled boiled water can be given after each breastfeed or half a sachet mixed in 4oz of bottle feeds.
  • Thickening Feeds: Carobel® can be used to thicken feeds, which may reduce reflux.
  • Domperidone: Some experts use domperidone to help with motility, often alongside omeprazole or similar proton pump inhibitors (PPI) to reduce acid production.
• Consider Fundoplication: In severe cases with failure to thrive, severe oesophagitis, apnoea, or bleeding, surgery (fundoplication) may be considered. This is typically considered if symptoms do not resolve by 6–9 months.

Prognosis

• Most cases of GORD in infants resolve by 6–9 months of age, as the gastrointestinal system matures.
• If symptoms persist beyond this period, further investigation and intervention may be required.

Conclusion

• GORD in children is often self-limiting and can be managed with reassurance, dietary changes, and medications.
• In more severe or persistent cases, medications and surgery may be required, but the majority of children improve by 6–9 months of age.