Materiały źródłowe

• #1 Reflux and Breastfeeding – The Breastfeeding Network

  https://www.breastfeedingnetwork.org.uk/factsheet/reflux/

  Some gastro-oesophageal reflux (GOR) occurs in most babies. Up to 40-50% of babies younger than 3 months regurgitate their feeds at least once a day (Craig 2004). Incidence peaks around 4 months. GOR is a normal physiological process that usually happens after eating in healthy infants, children, young people and adults. Most of us are familiar with it in the later stages of pregnancy. In reflux there is no retching as associated with a gastric infection, milk simply comes up and out of the babys mouth. […] Diagnosis is usually made by description of symptoms. […] NICE 2015 recommends to healthcare professionals that GOR is a normal physiological process in infancy. Parents should be reassured that it does not need any investigation or treatment unless the child presents with symptoms such as unexplained feeding difficulties, distressed behaviour, or faltering growth.

• #2 Diagnosis of GER & GERD in Infants – NIDDK

  https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-infants/diagnosis

  In most cases, doctors diagnose gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD) by reviewing an infants symptoms and medical history. […] If symptoms suggest that an infant may have a GERD complication or a health problem other than GERD, doctors may recommend medical tests. […] Doctors may refer an infant to a pediatric gastroenterologist to diagnose and treat GERD. […] Doctors may order the following tests to help diagnose GERD. […] Doctors may order additional tests to check for health problems other than GERD that might be causing an infants symptoms. […] Doctors may order this test to see how eating, sleeping, and symptoms relate to reflux in the esophagus. […] Doctors may also order this test to find out if GERD medicines are working. […] Doctors may order this test to check for problems, such as anatomic problems in the upper GI tract, that may be causing or worsening symptoms.

• #3 Gastroesophageal reflux in infants – UpToDate

  https://www.uptodate.com/contents/gastroesophageal-reflux-in-infants

  Gastroesophageal reflux (GER) is a normal physiologic process that occurs in healthy infants, children, and adults. Most episodes are brief and do not cause symptoms or esophageal injury or result in other complications. In contrast, gastroesophageal reflux disease (GERD) occurs when the reflux episodes are associated with complications such as esophagitis or poor weight gain. The diagnosis and management of GER in infants will be reviewed here. […] The diagnosis and management of GER in infants will be reviewed here. Reflux in premature infants, and the clinical manifestations, diagnosis, and pathophysiology of GERD in older children, are discussed separately. […] The range of symptoms and complications of GERD in children vary with the age of the child.

• #4 :: PGHN :: Pediatric Gastroenterology, Hepatology & Nutrition

  https://pghn.org/DOIx.php?id=10.5223/pghn.2019.22.2.107

  The diagnosis and management of gastro-esophageal reflux (GER) and GER disease (GERD) in infants and children remains a challenge. […] None of the signs and symptoms of GER and GERD are specific and there is no gold standard diagnostic test or tool. […] Clinical history and physical examination are important to identify alarm symptoms and signs and differentiate GERD from other disorders. […] The absence of a gold standard diagnostic tool hampers the diagnosis of GERD in infants and children further. […] However, GERD is a prominent phenomenon in children with underlying medical conditions, such as esophageal atresia, neurologic impairment and pulmonary problems, including cystic fibrosis. […] According to the guidelines of the NASPGHAN-ESPGHAN, refractory GERD is GERD which does not or insufficiently responds to optimal treatment after 8 weeks.

• #5 Diagnosis and Treatment of Gastroesophageal Reflux in Infants and Children | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/1015/p705.html

  Gastroesophageal reflux is defined as the passage of stomach contents into the esophagus with or without accompanied regurgitation (spitting up) and vomiting. […] The diagnoses of gastroesophageal reflux and GERD are based on the history and physical examination. Diagnostic tests, such as endoscopy, barium study, multiple intraluminal impedance, and pH monitoring, are reserved for when there are atypical symptoms, warning signs, doubts about the diagnosis, or suspected complications or treatment failure. […] The diagnosis of gastroesophageal reflux and GERD should be based primarily on history and physical examination findings because other diagnostic tests have not shown superior accuracy. […] Diagnostic testing is generally not necessary because it has not been found to be more reliable than the history and physical examination for diagnosing gastroesophageal reflux or GERD.

• #6 Infant acid reflux – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/infant-acid-reflux/diagnosis-treatment/drc-20351412

  To diagnose infant reflux, a healthcare professional typically starts with a physical exam and asks questions about a baby’s symptoms. If a baby is growing as expected and seems content, then testing usually isn’t needed. In some cases, however, a healthcare professional might recommend: […] Ultrasound. This imaging test can detect pyloric stenosis. […] Lab tests. Blood and urine tests can help find or rule out possible causes of poor weight gain and vomiting that happens often. […] Esophageal pH monitoring. To measure the acidity in a baby’s esophagus, the health professional places a thin tube through the baby’s nose or mouth and into the esophagus. The tube is attached to a device that monitors acidity. A baby might need to stay in the hospital while being monitored. […] X-rays. These images can detect problems in the digestive tract, such as a blockage. A baby may be given a contrast liquid with a bottle before the test. This liquid is usually barium.

• #7 Reflux in Babies: Signs & Treatment

  https://my.clevelandclinic.org/health/diseases/reflux-in-babies

  Reflux is when food from your babys stomach returns to their esophagus, which may lead to spitting up or vomiting. […] Reflux is common among babies in their first year and usually harmless. But its sometimes a sign of gastroesophageal reflux disease (GERD) or other conditions that need medical treatment. […] If your baby spits up a lot and youre worried, its worth having a conversation with your pediatrician. Theyll consider your babys symptoms and medical history to diagnose or rule out GERD and other possible medical conditions. […] Your pediatrician will review your babys medical history and do a physical exam. They need to find out if your babys reflux is something theyll outgrow (GER) or a disease that may need treatment (GERD). […] If they suspect GERD, theyll look for signs of complications. They must also rule out other conditions that have the same signs and symptoms as acid reflux.

• #8 Reflux in Babies: Signs & Treatment

  https://my.clevelandclinic.org/health/diseases/reflux-in-babies

  Reflux is when food from your babys stomach returns to their esophagus, which may lead to spitting up or vomiting. […] Reflux is common among babies in their first year and usually harmless. But its sometimes a sign of gastroesophageal reflux disease (GERD) or other conditions that need medical treatment. […] If your baby spits up a lot and youre worried, its worth having a conversation with your pediatrician. Theyll consider your babys symptoms and medical history to diagnose or rule out GERD and other possible medical conditions. […] Your pediatrician will review your babys medical history and do a physical exam. They need to find out if your babys reflux is something theyll outgrow (GER) or a disease that may need treatment (GERD). […] If they suspect GERD, theyll look for signs of complications. They must also rule out other conditions that have the same signs and symptoms as acid reflux.

• #9 Diagnosing GERD in Neonates? Be Cautious – Pediatrics Nationwide

  https://pediatricsnationwide.org/2016/10/18/diagnosing-gerd-in-neonates-be-cautious/

  Gastroesophageal reflux disease is likely over-diagnosed in neonates, leading to unnecessary and harmful treatment. […] Approximately 10 percent of infants born preterm in the United States are diagnosed with gastroesophageal reflux disease (GERD). But it’s almost certain that not all of those babies actually have GERD, say neonatologists at Nationwide Children’s Hospital. […] “There is no consensus about how best to make the diagnosis of GERD in neonates,” says Dr. Jadcherla, who is also a professor of Pediatrics at The Ohio State University College of Medicine “Most neonatologists, gastroenterologists and ear, nose and throat specialists make the diagnosis subjectively based on airway and digestive symptoms – breathing disturbances, cough, spit up, irritability, arching and feeding difficulties. It’s true that GERD can cause those symptoms. Many other conditions can cause those symptoms as well, though.”

• #10 Diagnosis and Treatment of Gastroesophageal Reflux in Infants and Children | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/1015/p705.html

  Gastroesophageal reflux is defined as the passage of stomach contents into the esophagus with or without accompanied regurgitation (spitting up) and vomiting. […] The diagnoses of gastroesophageal reflux and GERD are based on the history and physical examination. Diagnostic tests, such as endoscopy, barium study, multiple intraluminal impedance, and pH monitoring, are reserved for when there are atypical symptoms, warning signs, doubts about the diagnosis, or suspected complications or treatment failure. […] The diagnosis of gastroesophageal reflux and GERD should be based primarily on history and physical examination findings because other diagnostic tests have not shown superior accuracy. […] Diagnostic testing is generally not necessary because it has not been found to be more reliable than the history and physical examination for diagnosing gastroesophageal reflux or GERD.

• #11 Gastroesophageal Reflux in Infants and Children: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2025/0100/gastroesophageal-reflux-infants-children.html

  Gastroesophageal reflux is a common physiologic event in infants in which gastric contents pass from the stomach into the esophagus. Gastroesophageal reflux may be asymptomatic or cause regurgitation or spit up. This occurs daily in approximately 40% of infants. Symptoms often begin before 8 weeks of life, peak at approximately 4 months of age, and usually resolve by 1 year. The prevalence of gastroesophageal reflux is 2% to 8% in children and adolescents. Family physicians should reassure parents that gastroesophageal reflux is self-limited, not pathologic, and does not warrant routine testing or pharmacologic treatment. Gastroesophageal reflux may progress to gastroesophageal reflux disease when the reflux leads to troublesome symptoms (eg, recurrent postprandial expressions of distress or pain, coughing, choking) or causes complications, such as esophageal stricture or reflux esophagitis.

• #12 Infant GORD and reflux: Diagnosis and management – Medical Independent

  https://www.medicalindependent.ie/clinical-news/infant-gord-and-reflux-diagnosis-and-management/

  Diagnosis should be reconsidered if any of the following red flag signs and symptoms are present: Vomiting that is bilious, onset six months of age, or is consistent and forceful; Significant diarrhoea or constipation; Fever or lethargy; Abdominal rigidity; Hepatosplenomegaly; Bulging fontanelle and/or increasing head circumference. […] Current recommendations do not support an empiric trial of proton pump inhibitors (PPIs) as a diagnostic test for GORD in infants and young children because symptoms suggestive of GORD are not/less specific in children of this age group.

• #13 Reflux in babies | Information for the public | Gastro-oesophageal reflux disease in children and young people: diagnosis and management | Guidance | NICE

  https://www.nice.org.uk/guidance/ng1/ifp/chapter/reflux-in-babies

  Some symptoms of cows’ milk protein allergy can be similar to reflux symptoms, especially in babies who have eczema or asthma, or a family history of eczema or asthma. […] If your baby has any of the following problems, you should go back to see the healthcare professional: If the regurgitation becomes more forceful. […] If your baby brings up milk that is green or yellowish green (it could be bile, a bitter fluid that helps digestion), or if it looks as though it has blood in it. […] If your baby has any new problems or if things get worse such as if he or she will not stop crying or is very distressed, if your baby cannot feed, if he or she stops putting on weight, or if reflux is still a problem in a baby older than 1 year.

• #14 Pediatric Gastroesophageal Reflux Differential Diagnoses

  https://emedicine.medscape.com/article/930029-differential

  Vomiting is a symptom associated with many disorders. Accordingly, gastroesophageal reflux cannot be assumed to be the primary problem in infants and children who present with a history of emesis. Warning signals that herald the requirement for additional evaluation include the following: […] The occurrence of any of these signs and symptoms indicates the need to consider a comprehensive metabolic, neurologic, and/or surgical evaluation, in addition to a gastroenterologic workup. […] Conditions to consider in the differential diagnosis of gastroesophageal reflux include the following:

• #15 Infant reflux | Better Health Channel

  https://www.betterhealth.vic.gov.au/conditions-and-treatments/infant-reflux

  Reflux is common in babies and causes no pain or problems with weight gain in most babies. […] Reflux medications do not improve crying in most babies. […] In some cases, medications may help if your baby has a medical condition known as gastro-oesophageal reflux disease (GORD). […] Reflux in babies gets better with time as: They start to eat solids. They learn to sit up. The ring of muscle at the top of their stomach gets stronger. […] Research shows there is no link between baby’s reflux and crying time. […] Studies also show that if a baby doesn’t vomit, they are unlikely to have reflux. […] GORD is a medical condition that needs to be diagnosed by a doctor and affects small numbers of babies who have frequent vomiting AND other symptoms like: choking, coughing or wheezing during feeds, vomiting up blood, distress during feeds or refusal to feed, poor weight gain or weight loss.

• #16 Reflux in Babies: Signs & Treatment

  https://my.clevelandclinic.org/health/diseases/reflux-in-babies

  Most babies dont need diagnostic testing. Healthcare providers sometimes use testing if they need more information to reach a diagnosis. […] Your babys provider will tailor treatment to their needs. Possible treatments include medications for babies who clearly have GERD, and even then, only in select cases. […] If other measures arent enough to treat GERD or its complications, surgery may be an option.

• #17 Diagnosis of GER & GERD in Children – NIDDK

  https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-children/diagnosis

  In most cases, doctors diagnose gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD) by reviewing a child’s symptoms and medical history. […] Doctors may recommend medical tests if symptoms suggest that a child may have a health problem other than GERD or a complication of GERD. […] Doctors may also recommend tests if symptoms don’t improve with lifestyle changes or medicines. […] Doctors may refer a child to a pediatric gastroenterologist to diagnose and treat GERD. […] Doctors may order one or more of the following tests to help diagnose GERD and check for other health problems. […] Doctors may order an upper GI endoscopy to check for problems other than GERD or complications of GERD. […] Doctors may order this test to confirm the diagnosis of GERD or to find out if GERD treatments are working. […] Doctors may order this test to check for problems, such as anatomic problems in the upper GI tract, that may be causing or worsening symptoms.

• #18 Infant acid reflux – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/infant-acid-reflux/diagnosis-treatment/drc-20351412

  To diagnose infant reflux, a healthcare professional typically starts with a physical exam and asks questions about a baby’s symptoms. If a baby is growing as expected and seems content, then testing usually isn’t needed. In some cases, however, a healthcare professional might recommend: […] Ultrasound. This imaging test can detect pyloric stenosis. […] Lab tests. Blood and urine tests can help find or rule out possible causes of poor weight gain and vomiting that happens often. […] Esophageal pH monitoring. To measure the acidity in a baby’s esophagus, the health professional places a thin tube through the baby’s nose or mouth and into the esophagus. The tube is attached to a device that monitors acidity. A baby might need to stay in the hospital while being monitored. […] X-rays. These images can detect problems in the digestive tract, such as a blockage. A baby may be given a contrast liquid with a bottle before the test. This liquid is usually barium.

• #19 Acid reflux in infants: Causes, symptoms, and treatment

  https://www.medicalnewstoday.com/articles/315590

  Gastroesophageal reflux (GER) happens when the contents of the stomach wash back into the babys food pipe. It is defined as reflux without trouble, and usually resolves itself. […] Sometimes, a more severe and long-lasting form of gastroesophageal reflux called gastroesophageal reflux disease (GERD) can cause infant reflux. […] Diagnostic tests are not typically used for diagnosing GER or GERD. Diagnostic tests have not been found to be any more reliable than a doctor asking questions and carrying out a physical examination. […] If the baby is growing as expected, appears healthy, and seems content, no further testing is required. […] Doctors tend to use diagnostic testing if symptoms do not improve, no weight gain is observed, and lung problems are present. […] Methods of testing might include ultrasound, blood and urine tests, esophageal pH and impedance monitoring, X-rays, and upper endoscopy and biopsy.

• #20 Infant acid reflux – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/infant-acid-reflux/diagnosis-treatment/drc-20351412

  To diagnose infant reflux, a healthcare professional typically starts with a physical exam and asks questions about a baby’s symptoms. If a baby is growing as expected and seems content, then testing usually isn’t needed. In some cases, however, a healthcare professional might recommend: […] Ultrasound. This imaging test can detect pyloric stenosis. […] Lab tests. Blood and urine tests can help find or rule out possible causes of poor weight gain and vomiting that happens often. […] Esophageal pH monitoring. To measure the acidity in a baby’s esophagus, the health professional places a thin tube through the baby’s nose or mouth and into the esophagus. The tube is attached to a device that monitors acidity. A baby might need to stay in the hospital while being monitored. […] X-rays. These images can detect problems in the digestive tract, such as a blockage. A baby may be given a contrast liquid with a bottle before the test. This liquid is usually barium.

• #21 Gastroesophageal Reflux in Children – Children’s Health Issues – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/children-s-health-issues/gastrointestinal-disorders-in-children/gastroesophageal-reflux-in-children

  A barium study is the most common test. […] An esophageal pH probe is a thin flexible tube with a sensor at the tip that measures the degree of acidity (pH). […] An impedance probe is very similar to the esophageal pH probe but it can detect both acid and nonacid reflux. […] A gastric emptying scan is done to determine how quickly the stomach empties. […] In upper endoscopy, the child is sedated, and a small flexible tube with a camera on the end (endoscope) is passed through the mouth into the esophagus and stomach. […] An ultrasound of the abdomen may be done for infants who forcefully vomit, especially those who have lost weight and have complications of dehydration.

• #22 GERD in Infants | Causes | Symptoms | Complications | Diagnosis | Treatment

  https://www.icliniq.com/articles/gastro-health/gerd-in-infants

  Upper GI Series: It is a procedure in which a doctor uses barium to visualize the upper GI tract with X-rays. […] If your doctor suspects GER or GERD, they might suggest lifestyle modifications to overcome this problem. However, if the symptoms are severe, your doctor might recommend some tests to rule out GERD.

• #23 Infant acid reflux – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/infant-acid-reflux/diagnosis-treatment/drc-20351412

  To diagnose infant reflux, a healthcare professional typically starts with a physical exam and asks questions about a baby’s symptoms. If a baby is growing as expected and seems content, then testing usually isn’t needed. In some cases, however, a healthcare professional might recommend: […] Ultrasound. This imaging test can detect pyloric stenosis. […] Lab tests. Blood and urine tests can help find or rule out possible causes of poor weight gain and vomiting that happens often. […] Esophageal pH monitoring. To measure the acidity in a baby’s esophagus, the health professional places a thin tube through the baby’s nose or mouth and into the esophagus. The tube is attached to a device that monitors acidity. A baby might need to stay in the hospital while being monitored. […] X-rays. These images can detect problems in the digestive tract, such as a blockage. A baby may be given a contrast liquid with a bottle before the test. This liquid is usually barium.

• #24 Childhood gastroesophageal reflux disease: A comprehensive review of disease, diagnosis, and therapeutic management

  https://www.wjgnet.com/2219-2808/full/v14/i2/101175.htm

  This evaluation may include an upper GI barium study, ultrasound, esophageal manometry, a trial of proton pump inhibitors (PPIs), scintigraphy, esophagogastroduodenoscopy, esophageal pH monitoring, and multichannel intraluminal impedance (MII). […] Esophageal pH monitoring is a reliable and sensitive method for diagnosing GERD. […] A normal upper GI endoscopy does not rule out GERD, as its negative predictive value is low. […] Barium swallow and upper GI studies are used to evaluate anatomical abnormalities, such as tracheoesophageal fistula, achalasia, and hiatus hernia. […] Ultrasound has a high sensitivity and positive predictive value for GERD as it can evaluate both the esophagus’s anatomy and real-time reflux. […] Diagnosing GERD in children necessitates a multifaceted approach due to the diverse symptomatology and challenges in communication.

• #25 Childhood gastroesophageal reflux disease: A comprehensive review of disease, diagnosis, and therapeutic management

  https://www.wjgnet.com/2219-2808/full/v14/i2/101175.htm

  This evaluation may include an upper GI barium study, ultrasound, esophageal manometry, a trial of proton pump inhibitors (PPIs), scintigraphy, esophagogastroduodenoscopy, esophageal pH monitoring, and multichannel intraluminal impedance (MII). […] Esophageal pH monitoring is a reliable and sensitive method for diagnosing GERD. […] A normal upper GI endoscopy does not rule out GERD, as its negative predictive value is low. […] Barium swallow and upper GI studies are used to evaluate anatomical abnormalities, such as tracheoesophageal fistula, achalasia, and hiatus hernia. […] Ultrasound has a high sensitivity and positive predictive value for GERD as it can evaluate both the esophagus’s anatomy and real-time reflux. […] Diagnosing GERD in children necessitates a multifaceted approach due to the diverse symptomatology and challenges in communication.

• #26 Infant acid reflux – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/infant-acid-reflux/diagnosis-treatment/drc-20351412

  To diagnose infant reflux, a healthcare professional typically starts with a physical exam and asks questions about a baby’s symptoms. If a baby is growing as expected and seems content, then testing usually isn’t needed. In some cases, however, a healthcare professional might recommend: […] Ultrasound. This imaging test can detect pyloric stenosis. […] Lab tests. Blood and urine tests can help find or rule out possible causes of poor weight gain and vomiting that happens often. […] Esophageal pH monitoring. To measure the acidity in a baby’s esophagus, the health professional places a thin tube through the baby’s nose or mouth and into the esophagus. The tube is attached to a device that monitors acidity. A baby might need to stay in the hospital while being monitored. […] X-rays. These images can detect problems in the digestive tract, such as a blockage. A baby may be given a contrast liquid with a bottle before the test. This liquid is usually barium.

• #27 Diagnosis of GER & GERD in Infants – NIDDK

  https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-infants/diagnosis

  In most cases, doctors diagnose gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD) by reviewing an infants symptoms and medical history. […] If symptoms suggest that an infant may have a GERD complication or a health problem other than GERD, doctors may recommend medical tests. […] Doctors may refer an infant to a pediatric gastroenterologist to diagnose and treat GERD. […] Doctors may order the following tests to help diagnose GERD. […] Doctors may order additional tests to check for health problems other than GERD that might be causing an infants symptoms. […] Doctors may order this test to see how eating, sleeping, and symptoms relate to reflux in the esophagus. […] Doctors may also order this test to find out if GERD medicines are working. […] Doctors may order this test to check for problems, such as anatomic problems in the upper GI tract, that may be causing or worsening symptoms.

• #28 Pediatric Gastroesophageal Reflux Workup: Approach Considerations, Imaging Studies, Intraesophageal pH Probe Monitoring

  https://emedicine.medscape.com/article/930029-workup

  In most cases of gastroesophageal reflux, the diagnosis can be made from the history and physical examination. Conservative measures can be started empirically. However, if the presentation is atypical or if the response to therapy is minimal, further evaluation via imaging is warranted. […] This modality is useful in patients who are unresponsive to medical therapy. It allows for visualization of the mucosa for diagnosis of peptic ulcer disease, Helicobacter pylori infection, strictures, and peptic esophagitis. It also provides access to obtain biopsies for histopathologic examination. […] Although pH monitoring has become a widely overused modality, it remains the criterion standard for quantifying gastroesophageal reflux. […] Esophageal pH monitoring is not indicated in cases of obvious gastroesophageal reflux but is useful in demonstrating an association between reflux and symptoms in atypical presentations and in grading the risk of esophagitis. […] Intraluminal esophageal electrical impedance (EEI) is useful for detecting both acid reflux and nonacid reflux by measuring retrograde flow in the esophagus.

• #29 :: PGHN :: Pediatric Gastroenterology, Hepatology & Nutrition

  https://pghn.org/DOIx.php?id=10.5223/pghn.2019.22.2.107

  The indications to perform pH-MII are: 1) to measure the efficacy of acid suppression medication; 2) to differentiate NERD, hypersensitive esophagus, and functional heartburn in patients with normal endoscopies and histology; 3) to correlate persistent troublesome symptoms with acid and non-acid GER events; and 4) to establish the role of acid and non-acid reflux in the etiology of esophagitis and other signs and symptoms suggestive of GERD. […] In infants with overt regurgitation, in the absence of alarm symptoms, explaining the reasons why infants regurgitate (proportional large feeding volume, liquid feeding, supine position) and the natural evolution of the symptoms (spontaneous improvement between six and 18 months in the vast majority), to the parents is recommended. […] If nutritional management also remains unsuccessful, referral to a pediatric gastroenterologist is advised. […] In the absence of alarm symptoms, diagnostic investigations are not recommended at the primary healthcare level.

• #30 Gastroesophageal Reflux in Children – Stanford Medicine Children’s Health

  https://deprod.stanfordchildrens.org/en/topic/default?id=gastroesophageal-reflux-in-children-90-P02364

  In this test, a small, flexible tube (endoscope) is used to look at the inside of your child’s digestive tract. […] This test measures the level of acidity in your child’s esophagus. […] This test will show if your child’s stomach contents empty into their small intestine the correct way. Delayed gastric emptying can cause reflux. […] Call your child’s healthcare provider if your child vomits after every feeding or has new reflux symptoms.

• #31 Gastroesophageal Reflux in Children | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions—pediatrics/g/gastroesophageal-reflux.html

  Gastroesophageal reflux refers to the stomach and esophagus. […] Reflux can happen at any age, but it’s common in babies. […] The symptoms of this condition may be similar to symptoms of other health problems. Have your child see their healthcare provider for a diagnosis. […] Your child’s healthcare provider will examine your child and check their health history. Your child may need the following tests to diagnose reflux. […] A chest X-ray is done to look for signs of aspiration. […] An upper GI series looks at the organs in the upper part of your child’s digestive system. […] In this test, a small, flexible tube (endoscope) is used to look at the inside of your child’s digestive tract. […] This test measures the level of acidity in your child’s esophagus. […] This test will show if your child’s stomach contents empty into their small intestine the correct way. […] This test, which is also called esophageal manometry, is done to see if your child’s esophagus moves (contracts) correctly. […] Call your child’s healthcare provider if your child vomits after every feeding or has new reflux symptoms.

• #32 Diagnosis and Treatment of Gastroesophageal Reflux in Infants and Children | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/1015/p705.html

  Upper endoscopy with biopsy is considered when reflux does not respond to initial treatments. It is the principal method of evaluating the esophageal mucosa for complications of GERD and excluding other possible causes, such as eosinophilic esophagitis, esophageal webs, and infectious esophagitis. […] If symptoms do not improve with acid suppression therapy, diagnostic testing is warranted to evaluate treatment failure, identify complications of GERD, establish a relationship between atypical symptoms and reflux, and exclude other diagnoses.

• #33 Infant acid reflux – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/infant-acid-reflux/diagnosis-treatment/drc-20351412

  Upper endoscopy. An upper endoscopy uses a tiny camera on the end of a flexible tube called an endoscope to visually examine the upper digestive system. Tissue samples may be taken for analysis. For infants and children, endoscopy usually is done under general anesthesia. General anesthesia causes a sleeplike state before surgery or other medical procedures.

• #34 Diagnosis and Treatment of Gastroesophageal Reflux in Infants and Children | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/1015/p705.html

  Upper endoscopy with biopsy is considered when reflux does not respond to initial treatments. It is the principal method of evaluating the esophageal mucosa for complications of GERD and excluding other possible causes, such as eosinophilic esophagitis, esophageal webs, and infectious esophagitis. […] If symptoms do not improve with acid suppression therapy, diagnostic testing is warranted to evaluate treatment failure, identify complications of GERD, establish a relationship between atypical symptoms and reflux, and exclude other diagnoses.

• #35 Diagnosis of GER & GERD in Children – NIDDK

  https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-children/diagnosis

  In most cases, doctors diagnose gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD) by reviewing a child’s symptoms and medical history. […] Doctors may recommend medical tests if symptoms suggest that a child may have a health problem other than GERD or a complication of GERD. […] Doctors may also recommend tests if symptoms don’t improve with lifestyle changes or medicines. […] Doctors may refer a child to a pediatric gastroenterologist to diagnose and treat GERD. […] Doctors may order one or more of the following tests to help diagnose GERD and check for other health problems. […] Doctors may order an upper GI endoscopy to check for problems other than GERD or complications of GERD. […] Doctors may order this test to confirm the diagnosis of GERD or to find out if GERD treatments are working. […] Doctors may order this test to check for problems, such as anatomic problems in the upper GI tract, that may be causing or worsening symptoms.

• #36 Childhood gastroesophageal reflux disease: A comprehensive review of disease, diagnosis, and therapeutic management

  https://www.wjgnet.com/2219-2808/full/v14/i2/101175.htm

  This evaluation may include an upper GI barium study, ultrasound, esophageal manometry, a trial of proton pump inhibitors (PPIs), scintigraphy, esophagogastroduodenoscopy, esophageal pH monitoring, and multichannel intraluminal impedance (MII). […] Esophageal pH monitoring is a reliable and sensitive method for diagnosing GERD. […] A normal upper GI endoscopy does not rule out GERD, as its negative predictive value is low. […] Barium swallow and upper GI studies are used to evaluate anatomical abnormalities, such as tracheoesophageal fistula, achalasia, and hiatus hernia. […] Ultrasound has a high sensitivity and positive predictive value for GERD as it can evaluate both the esophagus’s anatomy and real-time reflux. […] Diagnosing GERD in children necessitates a multifaceted approach due to the diverse symptomatology and challenges in communication.

• #37 :: PGHN :: Pediatric Gastroenterology, Hepatology & Nutrition

  https://pghn.org/DOIx.php?id=10.5223/pghn.2019.22.2.107

  The sensitivity of erosive esophagitis in diagnosing GERD was reported to range from 15% up to 71% and the sensitivity of microscopic esophagitis in diagnosing GERD was between 83% and 88%. […] These findings indicate that a biopsy without the hallmarks of esophagitis or the absence of macroscopic lesions does not rule out the presence of GERD. […] However, endoscopy of the upper GI tract is useful to evaluate the mucosa in the presence of alarm symptoms or signs, such as hematemesis, dysphagia, or failure to thrive or anemia; to detect complications of GERD, such as erosive esophagitis, strictures, and Barrett’s esophagus; or to diagnose conditions that might mimic GERD, such as eosinophilic esophagitis. […] The correlation between esophagitis and acid exposure time on pH-monitoring is quite poor, particularly in infants.

• #38 Gastroesophageal Reflux in Infants and Children: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2025/0100/gastroesophageal-reflux-infants-children.html

  Diagnostic tests, such as endoscopy, barium study, multichannel intraluminal impedance, and pH monitoring, may be used when there is diagnostic uncertainty or alarm symptoms are present (eg, bilious or projectile vomiting, hematemesis). […] Infants and children who do not improve with conservative measures may require pharmacologic treatment, including an empiric trial of acid-suppression therapy for 4 to 8 weeks.

• #39 :: PGHN :: Pediatric Gastroenterology, Hepatology & Nutrition

  https://pghn.org/DOIx.php?id=10.5223/pghn.2019.22.2.107

  The indications to perform pH-MII are: 1) to measure the efficacy of acid suppression medication; 2) to differentiate NERD, hypersensitive esophagus, and functional heartburn in patients with normal endoscopies and histology; 3) to correlate persistent troublesome symptoms with acid and non-acid GER events; and 4) to establish the role of acid and non-acid reflux in the etiology of esophagitis and other signs and symptoms suggestive of GERD. […] In infants with overt regurgitation, in the absence of alarm symptoms, explaining the reasons why infants regurgitate (proportional large feeding volume, liquid feeding, supine position) and the natural evolution of the symptoms (spontaneous improvement between six and 18 months in the vast majority), to the parents is recommended. […] If nutritional management also remains unsuccessful, referral to a pediatric gastroenterologist is advised. […] In the absence of alarm symptoms, diagnostic investigations are not recommended at the primary healthcare level.

• #40 Diagnosis and Treatment of Gastroesophageal Reflux in Infants and Children | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/1015/p705.html

  Upper endoscopy with biopsy is considered when reflux does not respond to initial treatments. It is the principal method of evaluating the esophageal mucosa for complications of GERD and excluding other possible causes, such as eosinophilic esophagitis, esophageal webs, and infectious esophagitis. […] If symptoms do not improve with acid suppression therapy, diagnostic testing is warranted to evaluate treatment failure, identify complications of GERD, establish a relationship between atypical symptoms and reflux, and exclude other diagnoses.

• #41 Gastroesophageal Reflux in Infants – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/gastrointestinal-disorders-in-neonates-and-infants/gastroesophageal-reflux-in-infants

  Gastroesophageal reflux is the movement of gastric contents into the esophagus. […] Diagnosis is often made clinically and could include a trial of dietary change or in some instances a trial of acid-suppressing medication, but some infants require an upper gastrointestinal contrast x-ray series, use of esophageal pH and impedance probes, and sometimes endoscopy. […] Diagnosis of Reflux in Infants […] Clinical evaluation […] Typically upper gastrointestinal (GI) series […] Sometimes esophageal pH measurement or endoscopy. […] Infants who have symptoms consistent with GERD but no severe complications may be given a therapeutic trial of acid-reducing medication for GERD. Improvement or elimination of symptoms suggests that GERD is the diagnosis. […] If the diagnosis remains unclear or there is still a question of whether reflux is actually the cause of symptoms such as coughing or wheezing, a pediatric gastroenterologist may do tests using esophageal pH or impedance probes. […] Consider testing with an upper gastrointestinal contrast x-ray series, gastric emptying scan, esophageal pH probes, or endoscopy for infants with more severe GERD symptoms or for whom a therapeutic trial is not helpful.

• #42 Diagnosis of GE Reflux – Department of Pediatrics

  https://med.virginia.edu/pediatrics/clinical-and-patient-services/patient-tutorials/about-gastroesophageal-ge-reflux/diagnosis-of-ge-reflux/

  Most of the time, just hearing a parents story and seeing a child is enough to make the diagnosis of gastroesophageal (GE) reflux, but sometimes testing may be recommended. These tests are most commonly used to diagnose GE reflux: barium swallow or upper GI series, technetium gastric emptying study, pH probe, endoscopy with biopsies. […] In most cases, diagnosis of GE reflux can be made clinically based on a careful history and physical examination of the child. […] Diagnostic tests are primarily useful when trying to associate these types of unusual or severe symptoms with reflux, but offer little information about the ultimate outcome or appropriate treatment strategies.

• #43 Pediatric Gastroesophageal Reflux Differential Diagnoses

  https://emedicine.medscape.com/article/930029-differential

  Vomiting is a symptom associated with many disorders. Accordingly, gastroesophageal reflux cannot be assumed to be the primary problem in infants and children who present with a history of emesis. Warning signals that herald the requirement for additional evaluation include the following: […] The occurrence of any of these signs and symptoms indicates the need to consider a comprehensive metabolic, neurologic, and/or surgical evaluation, in addition to a gastroenterologic workup. […] Conditions to consider in the differential diagnosis of gastroesophageal reflux include the following:

• #44 How to Treat Forceful Vomiting (Pyloric Stenosis) | Banner

  https://www.bannerhealth.com/healthcareblog/better-me/does-my-baby-have-acid-reflux-or-pyloric-stenosis

  During your babys first eight weeks of life, they may experience reflux or gastroesophageal reflux disease, or GERD, a condition where contents in the stomach come back up and can cause spit up. […] No matter the cause, when babies are vomiting more than they are keeping down, when they arent voiding much urine or when they are failing to gain weight from excessive vomiting, a parent should have their baby observed by their treating physician, Dr. Lacey said. […] Your babys doctor will perform a physical examination and will ask detailed questions about your babys feeding and vomiting patterns. Theyll look for any weight loss or failure to maintain growth and will check for a lump in the abdomen. Typically, if there is a lump, it will feel like an olive, firm and movable. When pyloric stenosis seems likely, an abdominal ultrasound is usually done to confirm.

• #45 Reflux in babies | Information for the public | Gastro-oesophageal reflux disease in children and young people: diagnosis and management | Guidance | NICE

  https://www.nice.org.uk/guidance/ng1/ifp/chapter/reflux-in-babies

  Some symptoms of cows’ milk protein allergy can be similar to reflux symptoms, especially in babies who have eczema or asthma, or a family history of eczema or asthma. […] If your baby has any of the following problems, you should go back to see the healthcare professional: If the regurgitation becomes more forceful. […] If your baby brings up milk that is green or yellowish green (it could be bile, a bitter fluid that helps digestion), or if it looks as though it has blood in it. […] If your baby has any new problems or if things get worse such as if he or she will not stop crying or is very distressed, if your baby cannot feed, if he or she stops putting on weight, or if reflux is still a problem in a baby older than 1 year.

• #46 Childhood gastroesophageal reflux disease: A comprehensive review of disease, diagnosis, and therapeutic management

  https://www.wjgnet.com/2219-2808/full/v14/i2/101175.htm

  This evaluation may include an upper GI barium study, ultrasound, esophageal manometry, a trial of proton pump inhibitors (PPIs), scintigraphy, esophagogastroduodenoscopy, esophageal pH monitoring, and multichannel intraluminal impedance (MII). […] Esophageal pH monitoring is a reliable and sensitive method for diagnosing GERD. […] A normal upper GI endoscopy does not rule out GERD, as its negative predictive value is low. […] Barium swallow and upper GI studies are used to evaluate anatomical abnormalities, such as tracheoesophageal fistula, achalasia, and hiatus hernia. […] Ultrasound has a high sensitivity and positive predictive value for GERD as it can evaluate both the esophagus’s anatomy and real-time reflux. […] Diagnosing GERD in children necessitates a multifaceted approach due to the diverse symptomatology and challenges in communication.

• #47

  https://www.singhealth.com.sg/patient-care/conditions-treatments/ger-and-gerd

  Gastroesophageal Reflux (GER) occurs when there is a backflow of stomach contents into the throat and oesophagus (food pipe). Reflux is common in infants and symptoms include vomiting or frequent regurgitation (spitting up of milk) after feeding. As infants mature and gain better muscle tone of their lower oesophageal sphincter (a ring of muscle at the end of the food pipe), the symptoms of reflux usually resolve by the age of 6 months. […] Gastroesophageal Reflux Disease (GERD) is a less common and more severe form of reflux, resulting in inflammation of the oesophagus. Some infants are at a higher risk of developing GERD. This includes infants who are born premature and infants with underlying neuromuscular disorders (nerve/muscle problems). Besides having frequent regurgitation and vomiting, infants with GERD may have the following symptoms: Poor weight gain or weight loss, Fussy and irritable during or after feeding, Frequent back arching because of discomfort, Milk refusal or poor feeding.

• #48 Diagnosis and treatment of gastroesophageal reflux disease in infants and children

  https://www.wjgnet.com/1007-9327/full/v5/i5/375.htm

  Gastroesophageal reflux (GER) is a physiologic phenomenon occurring occasionally in every human being, especially during the postprandial period. Regurgitation occurs daily in almost 70% of 4-month-old infants and about 25% of their parents do consider regurgitation as a problem. […] Whether all infants presenting with regurgitation need drug treatment is a controversial question. […] GER is best defined as the involuntary passage of gastric contents into the esophagus. […] The usual manifestations and unusual presentations of GER (-disease) are listed in Table 1. Infants with a Roviralta Astoul syndrome have pyloric stenosis associated with hiatal hernia. […] Emesis and regurgitation are the most common symptoms of primary GER-disease but they are also a manifestation of many other diseases. Such secondary GER-disease can be caused by infections, metabolic disorders and especially food allergy. […] It is obvious that treatment of primary GER-disease should focus on motility and/or acid suppression, and that therapeutic management of secondary GER should focus on the etiologic phenomenon.

• #49 Diagnosis and treatment of gastroesophageal reflux disease in infants and children

  https://www.wjgnet.com/1007-9327/full/v5/i5/375.htm

  Gastroesophageal reflux (GER) is a physiologic phenomenon occurring occasionally in every human being, especially during the postprandial period. Regurgitation occurs daily in almost 70% of 4-month-old infants and about 25% of their parents do consider regurgitation as a problem. […] Whether all infants presenting with regurgitation need drug treatment is a controversial question. […] GER is best defined as the involuntary passage of gastric contents into the esophagus. […] The usual manifestations and unusual presentations of GER (-disease) are listed in Table 1. Infants with a Roviralta Astoul syndrome have pyloric stenosis associated with hiatal hernia. […] Emesis and regurgitation are the most common symptoms of primary GER-disease but they are also a manifestation of many other diseases. Such secondary GER-disease can be caused by infections, metabolic disorders and especially food allergy. […] It is obvious that treatment of primary GER-disease should focus on motility and/or acid suppression, and that therapeutic management of secondary GER should focus on the etiologic phenomenon.

• #50 Sandifer Syndrome: Symptoms, Causes & Outlook

  https://my.clevelandclinic.org/health/diseases/24082-sandifer-syndrome

  Your babys provider will diagnose Sandifer syndrome after taking a complete medical history and performing a physical exam to learn more about your childs symptoms. Tests arent usually necessary, but they can rule out conditions with similar symptoms to confirm a diagnosis. Tests might include: […] Managing GERD is the key to treating Sandifer syndrome. There are two ways to do that: dietary changes or taking medications. […] If changes to your babys diet dont work, your provider may recommend treatment with anti-reflux medications, including: […] After treatment begins, your babys symptoms should decrease or resolve over time. This could take a few weeks to a month. During treatment, your babys provider will monitor how they respond to dietary changes or medications to make sure your child is healthy and thriving.

• #51 Early Diagnosis of Infant Reflux May Prevent Asthma | NYU Langone News

  https://nyulangone.org/news/early-diagnosis-infant-reflux-may-prevent-asthma

  We hypothesized that young patients were being overdiagnosed with asthma when they might actually just be suffering from reflux, Dr. Pirzada explains. […] After a review of over 260 subject cases of infant reflux, their analysis showed that more than 50 percent of the cases included pulmonary symptoms, usually a cough, and the incidences of these symptoms rose to 84 percent in infants that also had eczema. […] Of note, these patients with pulmonary symptoms also went on to have higher rates of early-onset asthma at a median age of 8.4 months old. […] But if a child has reflux and eczema, our findings point to that infant being more prone to early-onset asthma. […] Whats most important to consider, is that GERD should be diagnosed and managed as early as possible to prevent potential long-term pulmonary complications, says Dr. Pirzada. […] Our promising research may lead us to better diagnose the risks of asthma in many young patients, allowing us to take precautions to avoid triggering that chronic condition that can last a lifetime.

• #52 Laryngopharyngeal Reflux and Children | Boston Medical Center

  https://www.bmc.org/patient-care/conditions-we-treat/db/laryngopharyngeal-reflux-and-children

  During the first year, infants frequently spit up. This is essentially LPR because the stomach contents are refluxing into the back of the throat. […] Only infants who have associated airway (breathing) or feeding problems require evaluation by a specialist. This is most critical when breathing-related symptoms are present. […] Infants and children are unable to describe sensations like adults can. Therefore, LPR is only successfully diagnosed if parents are suspicious and the child undergoes a full evaluation by a specialist such as an otolaryngologist. […] If parents notice any symptoms of LPR in their child, they may wish to discuss with their pediatrician a referral to see an otolaryngologist for evaluation. […] LPR in infants and children remains a diagnosis of clinical judgment based on history given by the parents, the physical exam, and endoscopic evaluations.

• #53 Over-diagnosis of reflux in infants leads to needless medication, research finds | ScienceDaily

  https://www.sciencedaily.com/releases/2013/04/130401104403.htm

  Medications used to treat gastroesophageal reflux disease, or GERD, are some of the most widely used medications in children less than one year old. […] Physicians often label common symptoms in infants, such as crying and spitting up, as disease. […] Frequent use of the GERD label can lead to overuse of medication. […] The study found that doctors’ use of the label GERD prompted parents to request medication for their baby even when they had been advised that the medication would probably be ineffective. […] Over-diagnosis of GERD can make a medical condition out of a normal behavior. […] Parents can learn from this study that a disease label can make them want medication for their child, regardless of whether the drugs are effective or not. […] Unnecessary use of medication is costly. […] The long-term side effects of the medication frequently prescribed to children diagnosed with GERD have not been fully studied.

• #54 Diagnosing GERD in Neonates? Be Cautious – Pediatrics Nationwide

  https://pediatricsnationwide.org/2016/10/18/diagnosing-gerd-in-neonates-be-cautious/

  Gastroesophageal reflux disease is likely over-diagnosed in neonates, leading to unnecessary and harmful treatment. […] Approximately 10 percent of infants born preterm in the United States are diagnosed with gastroesophageal reflux disease (GERD). But it’s almost certain that not all of those babies actually have GERD, say neonatologists at Nationwide Children’s Hospital. […] “There is no consensus about how best to make the diagnosis of GERD in neonates,” says Dr. Jadcherla, who is also a professor of Pediatrics at The Ohio State University College of Medicine “Most neonatologists, gastroenterologists and ear, nose and throat specialists make the diagnosis subjectively based on airway and digestive symptoms – breathing disturbances, cough, spit up, irritability, arching and feeding difficulties. It’s true that GERD can cause those symptoms. Many other conditions can cause those symptoms as well, though.”

• #55 Over-diagnosis of reflux in infants leads to needless medication, research finds | ScienceDaily

  https://www.sciencedaily.com/releases/2013/04/130401104403.htm

  Medications used to treat gastroesophageal reflux disease, or GERD, are some of the most widely used medications in children less than one year old. […] Physicians often label common symptoms in infants, such as crying and spitting up, as disease. […] Frequent use of the GERD label can lead to overuse of medication. […] The study found that doctors’ use of the label GERD prompted parents to request medication for their baby even when they had been advised that the medication would probably be ineffective. […] Over-diagnosis of GERD can make a medical condition out of a normal behavior. […] Parents can learn from this study that a disease label can make them want medication for their child, regardless of whether the drugs are effective or not. […] Unnecessary use of medication is costly. […] The long-term side effects of the medication frequently prescribed to children diagnosed with GERD have not been fully studied.

• #56 Over-diagnosis of reflux in infants leads to needless medication, research finds | ScienceDaily

  https://www.sciencedaily.com/releases/2013/04/130401104403.htm

  Medications used to treat gastroesophageal reflux disease, or GERD, are some of the most widely used medications in children less than one year old. […] Physicians often label common symptoms in infants, such as crying and spitting up, as disease. […] Frequent use of the GERD label can lead to overuse of medication. […] The study found that doctors’ use of the label GERD prompted parents to request medication for their baby even when they had been advised that the medication would probably be ineffective. […] Over-diagnosis of GERD can make a medical condition out of a normal behavior. […] Parents can learn from this study that a disease label can make them want medication for their child, regardless of whether the drugs are effective or not. […] Unnecessary use of medication is costly. […] The long-term side effects of the medication frequently prescribed to children diagnosed with GERD have not been fully studied.

• #57 Early Diagnosis of Infant Reflux May Prevent Asthma | NYU Langone News

  https://nyulangone.org/news/early-diagnosis-infant-reflux-may-prevent-asthma

  We hypothesized that young patients were being overdiagnosed with asthma when they might actually just be suffering from reflux, Dr. Pirzada explains. […] After a review of over 260 subject cases of infant reflux, their analysis showed that more than 50 percent of the cases included pulmonary symptoms, usually a cough, and the incidences of these symptoms rose to 84 percent in infants that also had eczema. […] Of note, these patients with pulmonary symptoms also went on to have higher rates of early-onset asthma at a median age of 8.4 months old. […] But if a child has reflux and eczema, our findings point to that infant being more prone to early-onset asthma. […] Whats most important to consider, is that GERD should be diagnosed and managed as early as possible to prevent potential long-term pulmonary complications, says Dr. Pirzada. […] Our promising research may lead us to better diagnose the risks of asthma in many young patients, allowing us to take precautions to avoid triggering that chronic condition that can last a lifetime.

• #58 Early Diagnosis of Infant Reflux May Prevent Asthma | NYU Langone News

  https://nyulangone.org/news/early-diagnosis-infant-reflux-may-prevent-asthma

  We hypothesized that young patients were being overdiagnosed with asthma when they might actually just be suffering from reflux, Dr. Pirzada explains. […] After a review of over 260 subject cases of infant reflux, their analysis showed that more than 50 percent of the cases included pulmonary symptoms, usually a cough, and the incidences of these symptoms rose to 84 percent in infants that also had eczema. […] Of note, these patients with pulmonary symptoms also went on to have higher rates of early-onset asthma at a median age of 8.4 months old. […] But if a child has reflux and eczema, our findings point to that infant being more prone to early-onset asthma. […] Whats most important to consider, is that GERD should be diagnosed and managed as early as possible to prevent potential long-term pulmonary complications, says Dr. Pirzada. […] Our promising research may lead us to better diagnose the risks of asthma in many young patients, allowing us to take precautions to avoid triggering that chronic condition that can last a lifetime.

• #59 Gastroesophageal Reflux in Infants – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/gastrointestinal-disorders-in-neonates-and-infants/gastroesophageal-reflux-in-infants

  Gastroesophageal reflux is the movement of gastric contents into the esophagus. […] Diagnosis is often made clinically and could include a trial of dietary change or in some instances a trial of acid-suppressing medication, but some infants require an upper gastrointestinal contrast x-ray series, use of esophageal pH and impedance probes, and sometimes endoscopy. […] Diagnosis of Reflux in Infants […] Clinical evaluation […] Typically upper gastrointestinal (GI) series […] Sometimes esophageal pH measurement or endoscopy. […] Infants who have symptoms consistent with GERD but no severe complications may be given a therapeutic trial of acid-reducing medication for GERD. Improvement or elimination of symptoms suggests that GERD is the diagnosis. […] If the diagnosis remains unclear or there is still a question of whether reflux is actually the cause of symptoms such as coughing or wheezing, a pediatric gastroenterologist may do tests using esophageal pH or impedance probes. […] Consider testing with an upper gastrointestinal contrast x-ray series, gastric emptying scan, esophageal pH probes, or endoscopy for infants with more severe GERD symptoms or for whom a therapeutic trial is not helpful.

• #60 Infant GORD and reflux: Diagnosis and management – Medical Independent

  https://www.medicalindependent.ie/clinical-news/infant-gord-and-reflux-diagnosis-and-management/

  Diagnosis should be reconsidered if any of the following red flag signs and symptoms are present: Vomiting that is bilious, onset six months of age, or is consistent and forceful; Significant diarrhoea or constipation; Fever or lethargy; Abdominal rigidity; Hepatosplenomegaly; Bulging fontanelle and/or increasing head circumference. […] Current recommendations do not support an empiric trial of proton pump inhibitors (PPIs) as a diagnostic test for GORD in infants and young children because symptoms suggestive of GORD are not/less specific in children of this age group.

• #61 Infant GORD and reflux: Diagnosis and management – Medical Independent

  https://www.medicalindependent.ie/nursing-in-general-practice/nigp-cpd-modules/infant-gord-and-refluxdiagnosis-and-management/

  Diagnosis should be reconsidered if any of the following red flag signs and symptoms are present: […] Infants should be referred to a specialist when regurgitation becomes persistently projectile; there is bile-stained vomiting or haematemesis; there are new concerns such as signs of marked distress, feeding difficulties or poor weight gain; and there is persistent, frequent regurgitation beyond the first year of life. […] Current recommendations do not support an empiric trial of proton pump inhibitors (PPIs) as a diagnostic test for GORD in infants and young children because symptoms suggestive of GORD are not/less specific in children of this age group. […]

• #62 Over-diagnosis of reflux in infants leads to needless medication, research finds | ScienceDaily

  https://www.sciencedaily.com/releases/2013/04/130401104403.htm

  Medications used to treat gastroesophageal reflux disease, or GERD, are some of the most widely used medications in children less than one year old. […] Physicians often label common symptoms in infants, such as crying and spitting up, as disease. […] Frequent use of the GERD label can lead to overuse of medication. […] The study found that doctors’ use of the label GERD prompted parents to request medication for their baby even when they had been advised that the medication would probably be ineffective. […] Over-diagnosis of GERD can make a medical condition out of a normal behavior. […] Parents can learn from this study that a disease label can make them want medication for their child, regardless of whether the drugs are effective or not. […] Unnecessary use of medication is costly. […] The long-term side effects of the medication frequently prescribed to children diagnosed with GERD have not been fully studied.

• #63 Recognizing Acid Reflux/GERD in Infants: 10 Common Signs

  https://www.healthline.com/health/gerd/recognize-gerd-infants

  Babies can get acid reflux due to underdeveloped esophagus muscles, leading to spitting and vomiting, feeding refusal, difficulty sleeping and growing, and frequent lung infections. […] Acid reflux happens when the contents of the stomach back up into the esophagus. […] Infants are more prone to acid reflux because their LES may be weak or underdeveloped. In fact, its estimated that more than half of all infants experience acid reflux to some degree. […] The condition usually peaks at age 4 months and goes away on its own between 12 and 18 months of age. […] Its rare for an infants symptoms to continue past 24 months. If they persist, it may be a sign of gastroesophageal reflux disease (GERD), which is a more severe condition. […] The doctor can rule out other conditions or confirm a GERD diagnosis.

• #64 Diagnosis and Treatment of Gastroesophageal Reflux in Infants and Children | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/1015/p705.html

  Gastroesophageal reflux is defined as the passage of stomach contents into the esophagus with or without accompanied regurgitation (spitting up) and vomiting. […] The diagnoses of gastroesophageal reflux and GERD are based on the history and physical examination. Diagnostic tests, such as endoscopy, barium study, multiple intraluminal impedance, and pH monitoring, are reserved for when there are atypical symptoms, warning signs, doubts about the diagnosis, or suspected complications or treatment failure. […] The diagnosis of gastroesophageal reflux and GERD should be based primarily on history and physical examination findings because other diagnostic tests have not shown superior accuracy. […] Diagnostic testing is generally not necessary because it has not been found to be more reliable than the history and physical examination for diagnosing gastroesophageal reflux or GERD.

• #65 Diagnosis of GER & GERD in Children – NIDDK

  https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-children/diagnosis

  In most cases, doctors diagnose gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD) by reviewing a child’s symptoms and medical history. […] Doctors may recommend medical tests if symptoms suggest that a child may have a health problem other than GERD or a complication of GERD. […] Doctors may also recommend tests if symptoms don’t improve with lifestyle changes or medicines. […] Doctors may refer a child to a pediatric gastroenterologist to diagnose and treat GERD. […] Doctors may order one or more of the following tests to help diagnose GERD and check for other health problems. […] Doctors may order an upper GI endoscopy to check for problems other than GERD or complications of GERD. […] Doctors may order this test to confirm the diagnosis of GERD or to find out if GERD treatments are working. […] Doctors may order this test to check for problems, such as anatomic problems in the upper GI tract, that may be causing or worsening symptoms.

• #66 Gastroesophageal Reflux Disease (GERD) in Infants: Feeding & Positioning | Nationwide Children’s Hospital

  https://www.nationwidechildrens.org/conditions/gastroesophageal-reflux-disease-gerd-in-infants

  Gastroesophageal reflux (GER) occurs when contents that have gone down to the stomach come back up into the esophagus. […] A doctor or health care provider can usually diagnose GERD based on your baby’s symptoms. […] Your baby may be referred to a stomach doctor (gastroenterologist). […] A doctor or health care provider may order these for your baby to diagnose GERD: Upper gastrointestinal (GI) endoscopy, Esophageal pH-impedance monitoring, Upper GI series.

• #67 Diagnosing GERD in Neonates? Be Cautious – Pediatrics Nationwide

  https://pediatricsnationwide.org/2016/10/18/diagnosing-gerd-in-neonates-be-cautious/

  Large-scale, well-controlled, long-term trials are needed to define true guidelines for diagnosing GERD, to learn how prevalent it is and to test multimodal therapies. For now, Dr. Jadcherla recommends 24-hour pH impedance and manometry studies, combined with observed symptoms, before making a diagnosis. […] “Neonatologists should be cautious about diagnosing GERD without objective tests,” he says. “Even if diagnosis and a decision to treat are made, the treatment should be a defined, short course based on improvement of symptoms.”

• #68 Diagnosing GERD in Neonates? Be Cautious – Pediatrics Nationwide

  https://pediatricsnationwide.org/2016/10/18/diagnosing-gerd-in-neonates-be-cautious/

  Large-scale, well-controlled, long-term trials are needed to define true guidelines for diagnosing GERD, to learn how prevalent it is and to test multimodal therapies. For now, Dr. Jadcherla recommends 24-hour pH impedance and manometry studies, combined with observed symptoms, before making a diagnosis. […] “Neonatologists should be cautious about diagnosing GERD without objective tests,” he says. “Even if diagnosis and a decision to treat are made, the treatment should be a defined, short course based on improvement of symptoms.”

• #69 Reflux in babies

  https://www.nhs.uk/conditions/reflux-in-babies/

  Reflux usually starts before a baby is 8 weeks old and gets better by the time they’re 1. […] Your baby does not usually need to see a doctor if they have reflux, as long as they’re happy, healthy and gaining weight. […] Non-urgent advice: See a GP if your baby: is not improving after trying things to ease reflux, gets reflux for the first time after they’re 6 months old, is older than 1 and still has reflux, is not gaining weight or is losing weight. […] A GP or specialist may sometimes recommend treatments for reflux. […] If the thickening powder does not help or your baby is breastfed, a GP or specialist might recommend medicines that stop your baby’s stomach producing as much acid. […] Very rarely, surgery might be needed to strengthen the muscles to stop food or milk travelling back up. This is usually only after trying other things or if their reflux is severe.

• #70 Early Diagnosis of Infant Reflux May Prevent Asthma | NYU Langone News

  https://nyulangone.org/news/early-diagnosis-infant-reflux-may-prevent-asthma

  We hypothesized that young patients were being overdiagnosed with asthma when they might actually just be suffering from reflux, Dr. Pirzada explains. […] After a review of over 260 subject cases of infant reflux, their analysis showed that more than 50 percent of the cases included pulmonary symptoms, usually a cough, and the incidences of these symptoms rose to 84 percent in infants that also had eczema. […] Of note, these patients with pulmonary symptoms also went on to have higher rates of early-onset asthma at a median age of 8.4 months old. […] But if a child has reflux and eczema, our findings point to that infant being more prone to early-onset asthma. […] Whats most important to consider, is that GERD should be diagnosed and managed as early as possible to prevent potential long-term pulmonary complications, says Dr. Pirzada. […] Our promising research may lead us to better diagnose the risks of asthma in many young patients, allowing us to take precautions to avoid triggering that chronic condition that can last a lifetime.

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