Refluks u niemowląt – Epidemiologia

Refluks u niemowląt
Epidemiologia

Refluks żołądkowo-przełykowy (GER) jest powszechnym zjawiskiem fizjologicznym u niemowląt, występującym u 40-65% zdrowych dzieci w wieku 1-4 miesięcy, z szczytem częstości objawów między 3 a 4 miesiącem życia (60-70%). Objawy GER ustępują samoistnie u około 60% niemowląt do 6 miesiąca życia i u 90% do 8-12 miesiąca życia. Choroba refluksowa przełyku (GERD) jest znacznie rzadsza, z zapadalnością około 1,48/1000 osobolat i częstością występowania u dzieci szacowaną na 1,25-3,3%. Czynniki ryzyka progresji do GERD obejmują wcześniactwo, niską masę urodzeniową, przepuklinę rozworu przełykowego, zaburzenia neurologiczne, ekspozycję na dym tytoniowy, wywiad rodzinny oraz sposób karmienia (niższe ryzyko u niemowląt karmionych piersią). Diagnostyka opiera się głównie na ocenie klinicznej, a badania dodatkowe, takie jak 24-godzinne monitorowanie pH czy wielokanałowa impedancja z pH-metrią, są zarezerwowane dla przypadków wątpliwych lub powikłanych.

Epidemiologia refluksu u niemowląt

Refluks żołądkowo-przełykowy (GER – gastroesophageal reflux) jest niezwykle powszechnym zjawiskiem fizjologicznym u niemowląt. Badania epidemiologiczne wskazują, że około 40-65% zdrowych niemowląt w wieku 1-4 miesięcy doświadcza refluksu¹. Dla większości niemowląt jest to stan przejściowy i samoograniczający się, który zazwyczaj ustępuje wraz z dojrzewaniem układu pokarmowego². W przeciwieństwie do tego, choroba refluksowa przełyku (GERD – gastroesophageal reflux disease) występuje znacznie rzadziej i definiowana jest jako refluks powodujący kłopotliwe objawy wpływające na codzienne funkcjonowanie lub powodujący powikłania³.

Częstotliwość występowania refluksu u niemowląt

Częstotliwość występowania refluksu u niemowląt wykazuje charakterystyczny wzorzec związany z wiekiem:

Około 85% niemowląt ulewa w pierwszym tygodniu życia⁴
Około 50% niemowląt w wieku do 3 miesięcy wykazuje codzienne objawy refluksu⁵⁶
Częstość refluksu osiąga szczyt w wieku 3-4 miesięcy, gdy około 60-70% niemowląt manifestuje kliniczne objawy refluksu⁴⁷
Około 66% niemowląt wykazuje codzienne objawy refluksu w wieku 4 miesięcy⁵
W wieku 6 miesięcy odsetek ten spada do około 60%⁴
Do 7 miesiąca życia liczba niemowląt z objawami refluksu zmniejsza się do 14%⁷⁵
W wieku 10-14 miesięcy odsetek ten spada poniżej 5%⁷⁵

Według niektórych badań, objawy refluksu ustępują samoistnie bez leczenia u 60% niemowląt do 6 miesiąca życia, gdy zaczynają przyjmować pozycję pionową i spożywać stałe pokarmy⁴. U około 90% niemowląt objawy ustępują do 8-10 miesiąca życia⁴, a według innych źródeł u 90% do 12 miesiąca życia⁸⁹.

Epidemiologia GERD u niemowląt

Choroba refluksowa przełyku (GERD) jest znacznie rzadszym zjawiskiem niż fizjologiczny refluks (GER). Dokładna ocena częstości występowania GERD u niemowląt jest trudna ze względu na niespecyficzność objawów i trudności diagnostyczne⁵. Badania wskazują jednak, że:

Zapadalność na GERD u niemowląt wynosi około 1,48 przypadku na 1000 osobolat¹⁰
Nieprawidłowe objawy i symptomy uzasadniające diagnozę GERD występują u około 1 na 300 niemowląt¹¹
Według niektórych badań, najwyższa częstość występowania GERD u niemowląt azjatyckich wynosi 26,5% w wieku 6 tygodni, następnie spada do 7,7% w wieku 3 miesięcy, 2,6% w wieku 6 miesięcy i ostatecznie 1,1% w wieku 12 miesięcy¹²
Francuskie badanie oszacowało, że 24,4% niemowląt (0-23 miesięcy) miało objawy GER, a częstość występowania GERD wynosiła 12,6%¹³
GERD osiąga szczyt w wieku 1 miesiąca (19%), a następnie spada z 9% w 3 miesiącu do 2% w 12 miesiącu życia¹⁴

Ogólnie, częstość występowania GERD u dzieci szacuje się na 1,25% do 3,3%, w porównaniu z 5% u dorosłych¹⁰. Warto zauważyć, że szacunkowo aż 25% dzieci może mieć objawy GERD¹⁵, co wskazuje na potencjalne przeszacowanie diagnozy w tej grupie wiekowej.

Czynniki ryzyka refluksu u niemowląt

Zidentyfikowano szereg czynników ryzyka, które mogą zwiększać prawdopodobieństwo wystąpienia refluksu u niemowląt oraz jego progresji do GERD:

Czynniki związane z niemowlęciem

Wcześniactwo – niemowlęta urodzone przedwcześnie mają wyższe ryzyko refluksu¹⁶¹⁷
Niska masa urodzeniowa – niemowlęta z niską masą urodzeniową są bardziej narażone na refluks¹⁸
Przepuklina rozworu przełykowego – zwiększa ryzyko GERD⁵¹⁶
Zaburzenia neurologiczne – dzieci z zaburzeniami dotyczącymi mózgu lub układu nerwowego, takimi jak mózgowe porażenie dziecięce, mają zwiększone ryzyko GERD⁵¹⁹
Mukowiscydoza – zwiększa podatność na GERD⁵
Padaczka – powiązana z wyższym ryzykiem GERD⁵
Wrodzone wady przełyku – dzieci urodzone z wadami przełyku mają większe ryzyko GERD⁵
Astma – zwiększa ryzyko i nasilenie objawów GERD⁵¹¹

Czynniki związane z żywieniem i stylem życia

Sposób karmienia – częstość występowania GERD jest niższa u niemowląt karmionych piersią niż u karmionych mlekiem modyfikowanym²⁰
Częste karmienia dużymi objętościami – przyczyniają się do refluksu²¹
Pozycja leżąca – zwiększa ryzyko refluksu²¹
Wyższy wskaźnik masy ciała (BMI) – powiązany z wyższą częstością występowania objawów GERD²²

Czynniki środowiskowe i genetyczne

Ekspozycja na dym tytoniowy – narażenie na dym tytoniowy ojca zidentyfikowano jako czynnik ryzyka GER i GERD w wieku 1 miesiąca¹⁴
Wywiad rodzinny – historia rodzinna refluksu zwiększa ryzyko wystąpienia GER i GERD¹⁴¹⁶
Różnice etniczne – istnieją różnice w wieku szczytowego występowania GERD między różnymi grupami etnicznymi²³

Czynniki związane z matką

Zaburzenia zdrowia psychicznego matki – matki z zaburzeniami zdrowia psychicznego mają prawie pięciokrotnie większe prawdopodobieństwo posiadania dziecka hospitalizowanego z powodu GOR/GORD w pierwszym roku po urodzeniu²⁴
Lęk matki – może przyczyniać się do nasilenia objawów refluksu²⁴

Monitorowanie i nadzór epidemiologiczny refluksu u niemowląt

Monitorowanie i nadzór epidemiologiczny refluksu u niemowląt są istotne dla zrozumienia naturalnego przebiegu choroby, identyfikacji grup ryzyka oraz oceny skuteczności interwencji. W praktyce klinicznej stosuje się różne metody:

Diagnostyka i rozpoznanie

Diagnostyka refluksu u niemowląt opiera się głównie na ocenie klinicznej²⁵. W większości przypadków dokładny wywiad kliniczny i badanie fizykalne są wystarczające do diagnozy²⁶. Pediatrzy oceniają objawy i schematy karmienia oraz monitorują wzrost dziecka przez nanoszenie jego wagi i wzrostu na siatkę centylową²⁵.

W przypadkach wątpliwych lub przy podejrzeniu powikłań, mogą być stosowane dodatkowe badania diagnostyczne:

24-godzinne monitorowanie pH – uważane za złoty standard w ilościowej ocenie refluksu i ocenie atypowych objawów, takich jak bezdech, stridor czy kaszel²⁷
Wielokanałowa impedancja przełykowa z pH-metrią (MII-pH) – zwiększa diagnostyczną wydajność w wykrywaniu refluksu pozaprzełykowego, szczególnie przy użyciu monitorowania wideo²⁸
Badanie kontrastowe górnego odcinka przewodu pokarmowego – może być odpowiednie przy podejrzeniu wad anatomicznych²⁷
Endoskopia z biopsją – może być przydatna w ocenie GERD opornego na leczenie²⁷

Warto podkreślić, że w większości przypadków niemowlęta z GER nie wymagają badań diagnostycznych, a badania są zarezerwowane dla przypadków poważniejszego GERD lub gdy istnieje podejrzenie innych schorzeń²⁹.

Systemy monitorowania epidemiologicznego

Nadzór epidemiologiczny refluksu u niemowląt prowadzony jest na różnych poziomach:

Badania kohortowe – śledzą naturalny przebieg refluksu w określonych populacjach niemowląt, jak w przypadku badania przeprowadzonego we wschodniej części Francji, które określiło częstość występowania i progresję GER i GERD u zdrowych niemowląt od urodzenia do 12 miesiąca życia¹³
Analizy rejestrów szpitalnych – dostarczają danych o hospitalizacjach związanych z refluksem, jak w badaniu z Nowej Południowej Walii, które wykazało, że refluks był siódmą najczęstszą przyczyną hospitalizacji niemowląt³⁰
Badania w podstawowej opiece zdrowotnej – dostarczają informacji o częstości występowania refluksu w populacji ogólnej, jak badanie, które wykazało, że problematyczny refluks zgłaszany jest przez rodziców podczas prawie 25% wizyt kontrolnych w wieku 6 miesięcy³¹
Analizy przepisywania leków – dają wgląd w praktyki leczenia refluksu, jak badanie z Nowej Zelandii, które wykazało wzrost liczby recept na omeprazol dla niemowląt poniżej 1 roku życia z 4650 do 8231 między 2006 a 2010 rokiem, mimo braku dowodów na skuteczność³²

Wyzwania w nadzorze epidemiologicznym

Monitorowanie epidemiologiczne refluksu u niemowląt napotyka na szereg wyzwań:

Zmienność definicji – zgłaszana częstość występowania refluksu różni się znacznie w zależności od metody zbierania danych i kryteriów stosowanych do definiowania objawów²²
Niespecyficzność objawów – wiele objawów GERD jest niespecyficznych i może wskazywać na wiele innych możliwych przyczyn lub stanów⁵
Brak złotego standardu diagnostycznego – specjaliści gastroenterologii dziecięcej wciąż nie mają złotego standardu narzędzia diagnostycznego dla tej choroby, co utrudnia dokładną i wczesną diagnozę u niemowląt⁶
Trudności w rozróżnieniu GER od GERD – odróżnienie małej liczby niemowląt z patologicznym GERD, które mogą odnieść korzyść z leczenia, od znacznie większej liczby niemowląt z fizjologicznym GER, stanowi wyzwanie kliniczne³³

Implikacje dla praktyki klinicznej

Zrozumienie epidemiologii refluksu u niemowląt ma istotne implikacje dla praktyki klinicznej:

Zapobieganie naddiagnozie i nadleczeniu

Biorąc pod uwagę powszechność fizjologicznego refluksu u niemowląt, kluczowe jest unikanie naddiagnozy i niepotrzebnego leczenia³⁴. Amerykańska Akademia Pediatrii (AAP) podkreśla znaczenie właściwej identyfikacji i leczenia dzieci z objawami refluksu oraz odróżnienia GER od poważniejszych zaburzeń, aby uniknąć niepotrzebnych terapii i kosztów²⁵.

W Nowej Zelandii zaobserwowano wzrost empirycznego leczenia omeprazolem w przypadku drażliwości niemowląt i refluksu, mimo że lek ten nie jest zatwierdzony do tego celu, jest mało prawdopodobne, aby poprawił objawy, a potencjalne działania niepożądane są w dużej mierze nieznane³². Omeprazol powinien być rozważany u niemowląt tylko w przypadkach ciężkiego zapalenia przełyku związanego z refluksem lub przy niepowodzeniu rozwoju³².

Postępowanie kliniczne

Postępowanie w przypadku refluksu u niemowląt powinno być dostosowane do nasilenia objawów:

Fizjologiczny GER – w większości przypadków nie wymaga leczenia poza zapewnieniem rodziców, ponieważ stan jest łagodny i samoograniczający się²⁶
GERD – leczenie jest stopniowane:
- Modyfikacje stylu życia i diety są pierwszą linią postępowania³⁵
- Farmakoterapia powinna być rozważana w leczeniu cięższego GERD u pacjentów, którzy nie reagują na środki zachowawcze²⁶
- Chirurgia antyrefluksowa jest wskazana u pacjentów ze znaczącym GERD, którzy są oporni na terapię medyczną²⁶

Warto zaznaczyć, że większość niemowląt z refluksem wyrasta z tego stanu, a operacje rzadko są zalecane dla niemowląt, ponieważ najprawdopodobniej wyrosną z GERD do 18 miesiąca życia³⁶.

Wsparcie dla rodziców

Refluks może być stresujący dla rodziców, a niepokój rodzicielski może nasilać objawy refluksu u dziecka³³. Dlatego ważne jest:

Zapewnienie rodziców, że refluks jest powszechny i zazwyczaj ustępuje wraz z wiekiem³⁷
Edukowanie rodziców na temat normalnej fizjologii i prawdopodobieństwa znacznego zmniejszenia objawów do 12 miesiąca życia³¹
Ocena zdrowia psychicznego rodziców, szczególnie matek, z niskim progiem pytania o zaburzenia zdrowia psychicznego okołoporodowego i ich leczenie³³

Standard jakości NICE QS112 określa, że wszystkie niemowlęta karmione piersią z częstym ulewaniem z wyraźnym niepokojem powinny mieć ocenione karmienie, ponieważ korekta techniki karmienia piersią może wyeliminować objawy³³.

Trendy i perspektywy

Analiza danych epidemiologicznych wskazuje na pewne trendy i perspektywy związane z refluksem u niemowląt:

Zmiany w częstości występowania

Częstość występowania GERD we wszystkich grupach wiekowych na całym świecie rośnie²⁰. W porównaniu do Wschodniej Azji, gdzie częstość występowania wynosi 8,5%, populacja Europy Zachodniej i Ameryki Północnej ma wyższą częstość występowania, wynoszącą 10% do 20%²⁰.

Badanie przeprowadzone w Chinach, Malezji, Rosji i Wietnamie wykazało, że refluks dotknął 61% niemowląt w wieku od 0 do 3 miesięcy, 32% niemowląt w wieku 3-6 miesięcy i 8% niemowląt w wieku 6-12 miesięcy³⁵.

Związek z innymi schorzeniami

Istnieje statystycznie istotny związek między GERD a innymi schorzeniami, takimi jak kręcz szyi (CMT)³⁸. Chociaż badanie zniechęca do tworzenia związków przyczynowych między tymi dwoma chorobami, badacze podkreślają, że związek między CMT a GERD jest statystycznie istotny³⁸.

Do 40% niemowląt z objawami GERD może mieć alergię na białko mleka krowiego niezależną od IgE (CMPA)²⁹. Czasami refluks u niemowląt może być spowodowany nietolerancją pokarmową³⁹.

Nowe podejścia do monitorowania i leczenia

Rozwijane są nowe metody monitorowania i leczenia refluksu u niemowląt:

Model żołądka niemowlęcia – opracowano model żołądka niemowlęcia do badania nowych potencjalnych produktów zagęszczających pokarm do tłumienia refluksu u noworodków i niemowląt⁴⁰
Specjalne formuły dla niemowląt – formuła zaprojektowana do leczenia ulewania i zagęszczona CBG, GOS i PHW skutecznie poprawiła objawy ulewania i jakość życia pacjentów w ciągu 14 dni stosowania⁴¹
Kwestionariusze oceniające objawy specyficzne dla wieku – pomogłyby w klinicznej diagnozie GERD, chociaż do tej pory żaden pojedynczy objaw lub zbiór objawów nie okazał się niezawodnie identyfikować pacjentów z GERD lub przewidywać odpowiedź na leczenie¹⁶

Prawdopodobnie wczesna identyfikacja i interwencja w przypadkach GERD w dzieciństwie zaowocuje poprawą wyników leczenia choroby, z mniejszą liczbą powikłań trwających całe życie i ogólnym zmniejszeniem zachorowalności, śmiertelności i kosztów opieki zdrowotnej¹⁶.

Potrzeba dalszych badań

Istnieje potrzeba dalszych badań w kilku obszarach:

Potrzebne są lepsze narzędzia diagnostyczne do odróżnienia GER od GERD³³
Konieczne jest lepsze zrozumienie czynników ryzyka i naturalnego przebiegu refluksu⁴²
Należy badać długoterminowe skutki przedłużających się objawów zaburzeń czynnościowych przewodu pokarmowego we wczesnym życiu, które mogą prowadzić do zwiększonego ryzyka tych zaburzeń w późniejszym życiu⁴¹
Proponowane jest nowe podejście do problemu refluksu, które uwzględnia wpływ wczesnego porodu (niedojrzałość), zaburzenia mikrobiomu (cięcie cesarskie) i zdrowia psychicznego (lęk matki)²⁴

Informacje o percepcji opiekunów i ich zachowaniach w odpowiedzi na objawy żołądkowo-jelitowe ich niemowląt mogą pomóc pracownikom służby zdrowia w opracowaniu lepszych podejść terapeutycznych i zapewnieniu edukacji kulturowo dostosowanej dla rodziców i opiekunów²³.

Podsumowanie epidemiologii refluksu u niemowląt

Refluks żołądkowo-przełykowy jest niezwykle powszechnym zjawiskiem fizjologicznym u niemowląt, dotykającym około 40-65% zdrowych niemowląt w pierwszych miesiącach życia. Częstość występowania refluksu osiąga szczyt między 3 a 4 miesiącem życia, a następnie stopniowo spada, ustępując prawie całkowicie u większości niemowląt do 12 miesiąca życia²²⁷.

Choroba refluksowa przełyku (GERD) jest znacznie rzadszym zjawiskiem, z częstością występowania szacowaną na 1,25-3,3% u dzieci. Identyfikacja czynników ryzyka, takich jak wcześniactwo, zaburzenia neurologiczne, ekspozycja na dym tytoniowy czy wywiad rodzinny refluksu, może pomóc w rozpoznaniu niemowląt narażonych na GERD¹⁴.

Wyzwaniem pozostaje odróżnienie fizjologicznego refluksu od patologicznego GERD, co prowadzi do ryzyka naddiagnozy i niepotrzebnego leczenia. Dalsze badania i lepsze narzędzia diagnostyczne są potrzebne, aby poprawić diagnozę i leczenie refluksu u niemowląt, zmniejszając tym samym obciążenie dla systemu opieki zdrowotnej i poprawiając jakość życia dotkniętych nim niemowląt i ich rodzin¹⁶³³.

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Materiały źródłowe

#1 Gastro-Esophageal Reflux in Children
https://www.mdpi.com/1422-0067/18/8/1671
Physiological gastro-esophageal reflux (GER) occurs in 40% to 65% of all otherwise healthy infants between the ages of one and four months making it a fairly characteristic condition of early postnatal life. […] GERD occurs when reflux of the gastric contents causes symptoms that are troublesome, affect the quality of life or cause pathologic complications. […] In children, the prevalence of food allergy is estimated to be approximately 6â8%, with some studies reporting prevalence even of up to 18%. […] The therapy of pediatric GERD is based on a combination of conservative measures (i.e., lifestyle and dietary modifications), pharmacological and, rarely, surgical treatment. […] The indications for surgical treatment still represent a âgrey areaâ in the management of pediatric GERD, as most of the literature on this topic is limited to retrospective series.
#2 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 occurs in almost all infants, manifesting as wet burps after feeding and/or spit-ups (the non-forceful return of milk or gastric contents to the esophagus, pharynx, and mouth). The incidence of gastroesophageal reflux increases between 2 months and 6 months of age (likely due to an increased volume of liquid at each feeding) and then starts to decrease after 7 months. Gastroesophageal reflux resolves in about 85% of infants by 12 months and in 95% by 18 months. Gastroesophageal reflux disease (GERD), ie, reflux that causes complications, is much less common. […] Gastroesophageal reflux disease (GERD) is diagnosed when reflux causes complications such as esophagitis, respiratory symptoms (eg, cough, stridor, wheezing, apnea), iron deficiency anemia, or impaired growth. […] 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.
#3 Medical management of gastro-esophageal reflux in healthy infants | Canadian Paediatric Society
https://cps.ca/en/documents/position/gastro-esophageal-reflux-in-healthy-infants
Clinical symptoms attributed to gastro-esophageal reflux disease (GERD) in healthy term infants are non-specific and overlap with age-appropriate behaviours. […] 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. Regurgitation or vomiting following most feeds has been reported in 20% of healthy infants at 1 month of age. This can increase to 41% between 3 and 4 months of age, then subsequently decreases, becoming rare after 1 year of age. […] Gastroesophageal reflux disease (GERD) occurs when GER leads to symptoms that affect daily functioning or to complications. […] The management of severe disease or GERD associated with comorbidities is beyond the scope of this document.
#4 Pediatric Gastroesophageal Reflux: Practice Essentials, Background, Etiology and Pathophysiology
https://emedicine.medscape.com/article/930029-overview
Gastroesophageal reflux is most commonly seen in infancy, with a peak at age 1-4 months. However, it can be seen in children of all ages, even healthy teenagers. […] Approximately 85% of infants vomit during the first week of life, and 60-70% manifest clinical gastroesophageal reflux at age 3-4 months. […] Symptoms abate without treatment in 60% of infants by age 6 months, when these infants begin to assume an upright position and eat solid foods. Resolution of symptoms occurs in approximately 90% of infants by age 8-10 months. The estimated prevalence of gastroesophageal reflux among children aged older than 1 year and adolescents ranges from 0.9-18.8%.
#5 Reflux in Babies: Signs & Treatment
https://my.clevelandclinic.org/health/diseases/reflux-in-babies
Reflux in babies is very common. About 50% of infants up to 3 months old show signs of reflux, like spitting up, at least once a day. About 66% of infants show daily signs of reflux by 4 months. But by 7 months, that number drops to 14%, and it’s less than 5% by 10 to 14 months. Most of these babies have GER, which is common in the first year and not a cause for concern. However, some of these babies have GERD. […] Researchers don’t know exactly how many babies have GERD. Many GERD symptoms are nonspecific. In other words, the symptoms aren’t specific to GERD but instead could point to many other possible causes or conditions. So, it can be hard to know for sure if a baby has GERD. […] Researchers do know that GERD is more likely to affect babies and children who: Have a hiatal hernia. Have disorders affecting their brain or nervous system. Have cystic fibrosis. Have epilepsy. Are born with conditions affecting their esophagus. Have asthma. Are born early (premature birth).
#6 Taking a Swing at „Reflux”: Evidence-based Information From a Pediatric PT — Boost Babies, LLC
https://www.boostbabiesaustin.com/blog/2020/7/21/taking-a-swing-at-reflux-evidence-based-information-from-a-pediatric-pt
Reflux is a hot topic among parents. As I started researching this large topic, I felt incredibly overwhelmed by how much information and misinformation actually exists with searches on social media and Google. Now, because reflux, also known as GER (Gastroesophogeal Reflux), is so common among infants, there is a large pool of people online sharing their own ideas, experiences, and treatments. 50% of infants spit up many times in first 3 months. 2/3 of all 4 month olds show signs and symptoms consistent with GERD. It is also worth mentioning that GI specialists still do not have a gold standard diagnostic tool for this disease, adding difficulty to accurate and early diagnosis in infants. […] The more time that passes after a feed, the higher the stomach acidity levels which is what damages the esophagus. When infants feed in smaller and more frequently feeds, they decrease stomach content acidity with spitting up and may decrease reflux occurrence. Supported sitting positions increase reflux more than other positions. Poor postural control in infants younger than 6 months contributes to a slumped posture in supported sitting. Overuse of seating positions like swings, bouncers, and car seats exacerbates reflux and limits infant exposure to movements delaying optimal gross motor development.
#7 Diagnosis and Treatment of Gastroesophageal Reflux in Infants and Children | AAFP
https://www.aafp.org/pubs/afp/issues/2015/1015/p705.html
Regurgitation is common during infancy, occurring at least once daily in one-half of infants up to three months of age. The prevalence peaks at four months of age, with two-thirds of infants regurgitating at least once daily and approximately 40% regurgitating with most feedings. Regurgitation declines precipitously afterward, dropping to 14% by seven months of age and to less than 5% between 10 and 14 months of age. Further decline in the incidence of regurgitation occurs during the second year of life. […] Gastroesophageal reflux symptoms remain common in childhood and adolescence. Approximately 2% to 7% of parents of three- to nine-year-olds report their child experiencing heartburn, epigastric pain, or regurgitation within the previous week, whereas 5% to 8% of adolescents report similar symptoms.
#8 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
Reflux is very common. It affects nearly half (at least 4 out of 10) of babies younger than 1 year. […] It tends to start before the baby is 8 weeks old. […] It gets better on its own in most babies (9 out of 10) by the time they are 1 year old.
#9 Reflux in Infants: MedlinePlus
https://medlineplus.gov/refluxininfants.html
Reflux is very common in babies. About half of all babies spit up many times a day in the first 3 months of their lives. They usually stop spitting up between the ages of 12 and 14 months. […] GERD is also common in younger infants. Many 4-month-olds have it. But by their first birthday, only 10% of babies still have GERD.
#10 Diagnosis and Treatment of Gastroesophageal Reflux in Infants and Children | AAFP
https://www.aafp.org/pubs/afp/issues/2015/1015/p705.html
GERD is much less common with an incidence of 1.48 cases per 1,000 person-years in infants, declining until 12 years of age, and then peaking at 16 to 17 years of age (2.26 cases in girls and 1.75 cases in boys per 1,000 person-years in 16- to 17-year-olds). Overall, the childhood prevalence of GERD is estimated at 1.25% to 3.3%, compared with 5% among adults.
#11 Gastroesophageal Reflux in Infants and Children | AAFP
https://www.aafp.org/pubs/afp/issues/2001/1201/p1853.html
Gastroesophageal reflux is a common, self-limited process in infants that usually resolves by six to 12 months of age. […] The prevalence of GER peaks between one to four months of age, and usually resolves by six to 12 months of age. […] Abnormal signs and symptoms that warrant a diagnosis of GERD occur in approximately one in 300 infants. […] After the first year of life, GERD is more resistant to complete resolution. […] A higher prevalence of GERD is present in children who have a history of esophageal atresia with repair; neurologic impairment and delay; hiatal hernia; bronchopulmonary dysplasia; asthma; and chronic cough. […] Gastroesophageal reflux disease (GERD) is a pathologic process in infants manifested by poor weight gain, signs of esophagitis, persistent respiratory symptoms, and changes in neurobehavior.
#12 Prevalence, risk factors and parental perceptions of gastroesophageal reflux disease in Asian infants in Singapore – Annals Singapore
https://annals.edu.sg/prevalence-risk-factors-and-parental-perceptions-of-gastroesophageal-reflux-disease-in-asian-infants-in-singapore/
The prevalence of infant GERD peaked at 26.5% at age 6 weeks, decreasing to 1.1% by 12 months. […] Prevalence of GERD in infants is highest in the first 3 months of life, and the majority outgrow it by 1 year of age. […] Current knowledge on the prevalence, natural history and factors contributing to infant GI disorders is limited. […] This study therefore aimed to describe the prevalence and natural history of GERD in infants during the first year of life in an Asian preconception cohort. […] The highest prevalence of GERD in infants was 26.5% (67/253) at age 6 weeks. This decreased to 7.7% (21/274) at 3 months, 2.6% (8/302) at 6 months and eventually 1.1% (3/273) at 12 months. […] A total of 1,054 women attended the recruitment visit, with 1,032 enrolled in the study. […] This study provides data on the epidemiology, risk factors, longitudinal course and social impact of GERD in an Asian paediatric population.
#13 Natural history of gastroesophageal reflux in infancy: new data from a prospective cohort
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7137340/
Gastroesophageal reflux (GER) is common in infants. Gastroesophageal reflux disease (GERD) is defined as GER leading to troublesome symptoms that affect daily functioning and/or complications. This study is aimed at determining the prevalence and progression of GER and GERD in a cohort of healthy term infants from birth to 12 months old. […] The prevalence of GER and GERD vary according to the population, the study design (cross-sectional or longitudinal), and the diagnostic criteria (visible symptoms vs. validated questionnaire). A French study estimated that 24.4% of infants (0-23 months) had symptoms of GER and the prevalence of GERD was 12.6%. […] The primary aim of our study was to determine the prevalence and the progression of GER and GERD in a cohort of infants from birth to one year of age in the eastern part of France.
#14 Natural history of gastroesophageal reflux in infancy: new data from a prospective cohort
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7137340/
The progression of physiological GER and GERD were markedly different. Whereas physiological GER peaked at 3 months of age (59.4%), GERD peaked at 1 month of age (19%). The prevalence of GERD thereafter dropped from 9% at 3 months to 2% at 12 months of age. […] We identified two risk factors for GER and GERD at 1 month of age: family history of GER and exposure to paternal smoking. […] In conclusion, in this prospective cohort study, the prevalence of GER was high in infants aged less than one year but most cases resolved spontaneously with time as infants got older. We identified two risk factors, one of which is preventable: environmental tobacco smoke exposure and family history of GER.
#15 Reflux in Children: MedlinePlus
https://medlineplus.gov/refluxinchildren.html
Many children have occasional reflux. GERD is not as common; up to 25% of children have symptoms of GERD. […] The primary NIH organization for research on Reflux in Children is the National Institute of Diabetes and Digestive and Kidney Diseases.
#16 Gastro-oesophageal reflux disease in children: identification and management – The Pharmaceutical Journal
https://pharmaceutical-journal.com/article/ld/gastro-oesophageal-reflux-disease-in-children-identification-and-management
The following factors are associated with an increased prevalence of GORD: Premature birth; Parental history of heartburn or acid regurgitation; Obesity; Hiatus hernia; History of congenital diaphragmatic hernia (repaired); History of congenital oesophageal atresia (repaired); Underlying neurodisability. […] European and North American Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN and NASPGHAN) guidelines list the conditions that put patients at a high risk of GORD complications. […] Age-specific, symptom-assessing questionnaires would help the clinical diagnosis of GORD. However, to date, no single symptom or collection of symptoms has been shown to reliably identify patients with GORD or predict response to treatment. […] It is likely that early identification and intervention in cases of GORD during childhood will result in an improved disease outcome, with fewer lifelong complications and an overall decrease in morbidity, mortality and healthcare costs.
#16 Gastro-oesophageal reflux disease in children: identification and management – The Pharmaceutical Journal
https://pharmaceutical-journal.com/article/ld/gastro-oesophageal-reflux-disease-in-children-identification-and-management
Gastro-oesophageal reflux (GOR) is the involuntary passage of gastric contents into the oesophagus. In children, it is often a simple physiological phenomenon â especially in infants in cases of regurgitation that appear to happen unnoticed by the child. Gastro-oesophageal reflux disease (GORD) occurs when the reflux of gastric contents causes troublesome symptoms and/or complications. It is one of the most common causes of foregut symptoms across all paediatric age groups. […] Regardless of the exact definition, GORD affects many children in the UK and, as parents and carers commonly seek medical advice, it constitutes a health burden for the NHS. […] Physiological GORD occurs in around 40â65% of all otherwise healthy infants aged between 1 and 4 months. Symptoms may begin before 8 weeks of age and become less frequent over time in around 90% of affected infants before they are 1 year.
#17 Infant reflux | UM Health-Sparrow
https://www.uofmhealthsparrow.org/departments-conditions/conditions/infant-reflux
Infant reflux is common. But some things make it more likely that a baby will have infant reflux. These include: Premature birth, Lung conditions, such as cystic fibrosis, Conditions that affect the nervous system, such as cerebral palsy, Previous surgery on the esophagus. […] If your baby has a more serious condition such as GERD, your baby’s growth may lag behind that of other children. Some research suggests that babies who have frequent episodes of spitting up might be more likely to develop GERD later in childhood. […] 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. […] Reflux medicines aren’t typically used in children to treat reflux that isn’t complicated. But a healthcare professional may recommend an acid-blocking medicine for several weeks or months. […] Rarely, a baby may need surgery. This is only done if a baby is not gaining enough weight or has trouble breathing because of reflux. During the surgery, the LES between the esophagus and the stomach is tightened. This prevents acid from flowing back up into the esophagus.
#18 Childhood Gastro-oesophageal Reflux: Causes and Treatment
https://patient.info/childrens-health/childhood-gastro-oesophageal-reflux-leaflet
Gastro-oesophageal reflux is very common in babies and young children. Regurgitation of a small quantity of milk after a feed without any other symptoms (possetting) is harmless in young infants and doesn’t need any investigations or treatment. […] Gastro-oesophageal reflux is more common in babies who are born prematurely and also in those who have a very low birth weight. It is also more common in babies or children who have some impairment of their muscles and nerves (for example, those with cerebral palsy) or those with cow’s milk allergy. […] The vast majority of children do not need any treatment with medicines for their reflux. Acid-reducing medicines do not help possetting or GOR. […] As mentioned before, reflux is a self-limiting condition for the vast majority of babies and infants. It usually improves completely by the age of 18 months, even without any treatment.
#19 GERD (Gastroesophageal Reflux Disease) in Children
https://www.nationwidechildrens.org/conditions/health-library/gerd-gastroesophageal-reflux-disease-in-children
GER is common in babies under 2 years old. […] In most cases, babies outgrow this by the time they are 12 to 14 months old. […] Your child is more at risk for GERD if they have: Down syndrome, Neuromuscular disorders, such as muscular dystrophy and cerebral palsy. […] GERD symptoms may seem like other health problems. […] Some babies and children who have GERD may not vomit. But their stomach contents may still move up the food pipe (esophagus) and spill over into the windpipe (trachea). […] The vomiting that affects many babies and children with GERD can cause problems with weight gain and poor nutrition. […] Over time, when stomach acid backs up into the esophagus, it can also lead to: Inflammation of the esophagus, called esophagitis, Sores or ulcers in the esophagus, which can be painful and may bleed, A lack of red blood cells, from bleeding sores (anemia).
#20 Gastroesophageal Reflux Disease Management in Pediatric Patients
https://www.uspharmacist.com/article/gastroesophageal-reflux-disease-management-in-pediatric-patients
The prevalence of GERD in all age groups worldwide is increasing. In comparison to Eastern Asia, where the prevalence is 8.5%, the Western European and North American population have a higher prevalence of 10% to 20%. Those in the pediatric population considered to be at high risk for GERD are listed in TABLE 1. Pediatric patients with conditions that render them at high risk for GERD may be more prone to developing complications of severe GERD compared to healthy children. […] The incidence of GERD is reported to be lower in breastfed infants than in formula-fed infants. In general, GERD may cause symptoms without necessarily interfering with growth. However, those children with clinically significant GERD or diagnosed with esophagitis may develop an aversion to food due to the stimulus-response associated as a result of pain with eating.
#21 Acid reflux in infants: Causes, symptoms, and treatment
https://www.medicalnewstoday.com/articles/315590
Most risk factors for infant GER are unavoidable and include: Temporary relaxation of lower esophageal sphincter after feeding, Frequent large-volume feedings, Short food pipe, Laying down. […] GER is uncomplicated, and infants with this type of reflux are often called happy spitters. […] However, in contrast, symptoms of GERD in infants include: Poor weight gain, weight loss, and failure to thrive, Feeding refusal or lengthy feedings, Irritability after eating, Difficulty swallowing or pain when swallowing, Frequent vomiting, Stomach pain, chest pain, and pain in other abdominal areas, Long-term coughing, wheezing, or hoarseness, Asthma, Recurring laryngitis, pneumonia, sinusitis, or inflammation of the middle ear. […] If an infant presents symptoms of GERD, it is important to get advice from a doctor or pediatrician as other, more severe, conditions share some of the symptoms of reflux in infants.
#22 Prevalence of Gastroesophageal Reflux Disease Symptoms in Infants and Children: A Systematic Review – PubMed
https://pubmed.ncbi.nlm.nih.gov/31124988/
Gastroesophageal reflux disease (GERD) is defined as gastroesophageal reflux causing troublesome symptoms or complications. […] In total, 3581 unique studies were found, of which 25 studies (11 in infants and 14 in children) were included with data on the prevalence of GERD symptoms comprising a total population of 487,969 children. In infants (0-18 months), GERD symptoms are present in more than a quarter of infants on a daily basis and show a steady decline in frequency with almost complete disappearance of symptoms at the age of 12 months. […] Of the risk factors assessed, higher body mass index and the use of alcohol and tobacco were associated with higher GERD symptom prevalence. […] This systematic review demonstrates that the reported prevalence of GERD symptoms varies considerably, depending on method of data collection and criteria used to define symptoms.
#23 Prevalence, risk factors and parental perceptions of gastroesophageal reflux disease in Asian infants in Singapore – Annals Singapore
https://annals.edu.sg/prevalence-risk-factors-and-parental-perceptions-of-gastroesophageal-reflux-disease-in-asian-infants-in-singapore/
The highest prevalence of GERD in our population was at age 6 weeks. The prevalence decreased rapidly with age and almost all infants outgrew GERD by 1 year. […] A major difference in infant GERD between different ethnic groups is the variation in the age at peak prevalence. […] Exclusively breastfed infants in this cohort had a reduced odds of GERD, but the mode of breast milk feeding did not appear to impact GERD risk. […] The information on caregivers perceptions and behaviours in response to their infants GI symptoms can aid healthcare practitioners to develop better therapeutic approaches and provide culturally aligned education for parents and caregivers.
#24 Gastro-oesophageal reflux: a mixed methods study of infants admitted to hospital in the first 12Â months following birth in NSW (2000â2011) | BMC Pediatrics | Full Text
https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-018-0999-9
Thirty six percent of infants admitted to residential parenting centres in NSW had been given a diagnosis of GOR/GORD. […] Mothers with a mental health disorder are nearly five times as likely to have a baby admitted with GOR/GORD in the first year after birth. We propose a new way of approaching the GOR/GORD issue that considers the impact of early birth (immaturity), disturbance of the microbiome (caesarean section) and mental health (maternal anxiety in particular). […] The fact that mothers with a mental health disorder are nearly five times as likely to have a baby admitted with GOR/GORD in the first year after birth calls for a re-think about this issue. We propose a new way of approaching the GOR/GORD issue that considers the impact of early birth (the immature infant), disturbance of the microbiome (caesarean section) and maternal mental health (anxiety).
#25
https://www.healthychildren.org/English/health-issues/conditions/abdominal/Pages/GERD-Reflux.aspx
GER usually begins at about 2 to 3 weeks of age and peaks between 4 to 5 months old. For most babies born full-term, symptoms go away by the time they are 9 to 12 months old; GER disappears as upper digestive tract function matures. […] The AAP believes it is important for all pediatric health care providers to be able to properly identify and treat children with reflux symptoms and to tell GER apart from more worrisome disorders. This can avoid unnecessary treatments and costs. […] Your child’s pediatrician will review your child’s symptoms and feeding patterns. They will also assess their growth by plotting their weight and height on a growth chart. This information will help them determine whether your child is a „happy spitter” or has symptoms of GERD.
#26 Gastroesophageal reflux in children: an updated review – Drugs in Context
https://www.drugsincontext.com/gastroesophageal-reflux-in-children-an-updated-review/
Gastroesophageal reflux is a common disorder in pediatrics. Gastroesophageal reflux occurs normally in infants, is often physiological, peaks at 4 months of age, and tends to resolve with time. Gastroesophageal reflux disease occurs when gastric contents reflux into the esophagus or oropharynx and produce troublesome symptom(s) and/or complication(s). A thorough clinical history and a thorough physical examination are usually adequate for diagnosis. In most cases, no treatment is necessary for gastroesophageal reflux apart from reassurance because the condition is benign and self-limiting. […] Treatment options for gastroesophageal reflux disease are discussed. […] Pharmacotherapy should be considered in the treatment of more severe gastroesophageal reflux disease for patients who do not respond to conservative measures. Antireflux surgery is indicated for patients with significant gastroesophageal reflux disease who are resistant to medical therapy.
#27 Gastroesophageal Reflux in Infants and Children | AAFP
https://www.aafp.org/pubs/afp/issues/2001/1201/p1853.html
Other GI and systemic disorders must first be excluded before considering GERD as the main cause of an infant’s or child’s symptoms of silent or visible regurgitation or vomiting. […] In most cases of GER, no diagnostic study is required. […] Consultation with a pediatric gastroenterologist may be necessary to select the most appropriate study for individual patients. […] If conservative therapy and a trial of casein hydrolysate formula do not improve symptoms and other differential diagnoses have been considered, medical therapy is likely warranted. […] An upper GI examination may be the most appropriate study if there is a concern about anatomic defects, especially if a prokinetic agent will be administered. […] The 24-hour pH probe monitoring may be considered the gold standard test for quantitating reflux and for evaluating atypical symptoms such as apnea, stridor, or cough. […] Endoscopy with biopsy may be useful to evaluate GERD that is unresponsive to medical therapy.
#28 Prevalence of gastroesophageal reflux disease in children with extraesophageal manifestations using combined-video, multichannel intraluminal impedance-pH study
https://www.wjgnet.com/2219-2808/full/v12/i3/151.htm
Gastroesophageal reflux disease (GERD) might be either a cause or comorbidity in children with extraesophageal problems especially as refractory respiratory symptoms, without any best methods or criterion for diagnosing it in children. […] The incidence of GERD has increased in children (0.84 per 1000 persons-year). […] The prevalence of extraesophageal GERD was 35.3% by using the MII-pH study in this study. […] Total symptom record, longest reflux time (LRT), and mean nocturnal baseline impedance (MNBI) were the parameters that were significantly different between the GERD and non-GERD groups. […] Using video monitoring during MII-pH study to depict more symptom record increases the diagnostic yield of extraesophageal GERD. […] The prevalence of GERD was not as high as expected. Employing video monitoring into conventional MII-pH study increases the diagnostic yield of symptom indices. LRT and MNBI are novel parameters that should be integrated into the diagnostic criteria for GERD.
#29 Gastrooesophageal reflux disease in infants
https://www.rch.org.au/clinicalguide/guideline_index/Gastrooesophageal_reflux_disease_in_infants/
Gastro-oesophageal reflux is common, affecting at least 40% of infants […] usually begins before 8 weeks of age, peaks at 4 months and resolves by 1 year of age in majority of cases […] GORD is not a common cause of unexplained crying, irritability or distressed behaviour in otherwise healthy infants […] There is insufficient evidence to support the diagnosis or management of „silent reflux” […] Both GOR and GORD can be diagnosed on detailed history and examination […] Investigations for GORD (such as barium contrast radiography, pH probe, endoscopy) are rarely necessary, and are not diagnostic […] Up to 40% of infants presenting with symptoms of GORD will have non-IgE mediated Cow Milk Protein Allergy (CMPA) […] Acid suppressant therapy may be indicated in specific patients with GORD
#30 Infantile gastroesophageal reflux in a hospital setting | BMC Pediatrics | Full Text
https://bmcpediatr.biomedcentral.com/articles/10.1186/1471-2431-8-11
Gastroesophageal reflux is a common diagnosis in infants. Yet, there is no information on the demographics of those hospitalized with reflux. The aim of this study is to describe the demographics of children with gastroesophageal reflux discharged from the hospital during the first two years of life. […] Reflux was the seventh most common reason for hospitalization. About 50% of subjects with reflux had multiple hospitalizations. Of the 1,096 infants diagnosed with reflux about half were born prematurely. Reflux was the primary diagnosis for 21% of all infants; 10% of those born prematurely. […] Reflux is a common discharge diagnosis. Children who have primary reflux have longer than average hospital stays. About half had multiple admissions. […] This is the first report on the demographics of children with reflux who are sick enough to be hospitalized.
#31 Parental Concerns on Gastroesophageal Reflux | Springer Publishing
https://connect.springerpub.com/highwire_display/entity_view/node/67913/full
Even though statistics show GER to be quite common, a pediatric practice-based study by Nelson, Chen, Syniar, and Christoffel (1997), found perceived problematic GER is brought up by parents at nearly 25% of 6 month well visits. […] NASPGHAN and ESPGHAN recommend educating, supporting, and reassuring parents of this normal physiology (Vandenplas et al., 2009) that is likely to decrease significantly by 12 months of age (Campanozzi et al., 2009). […] IBCLCs can gather a history and observe a feeding and they are often present to observe the episodes of GER. […] NASPGHAN and ESPGHAN offer warning signs of more complicated GER when accompanied with other symptoms. These signs include bilious vomiting, gastrointestinal bleeding, consistent forceful vomiting, lethargy, failure to thrive, diarrhea, constipation, fever, abdominal tenderness or distension, bulging fontanelle, and documented or suspected genetic or metabolic syndromes (Vandenplas et al., 2009). […] The difficulty in distinguishing between normal and problematic GER is multifactorial. […] It is not within the scope of practice for IBCLCs to diagnose, but they are sometimes in the position of recognizing an infants need for further medical attention and interventions.
#32
https://bpac.org.nz/BPJ/2011/november/infant-reflux.aspx
Referral to a paediatrician (or paediatric gastroenterologist where available) for diagnostic investigations is indicated when an infant has excessive reflux and: a failure of conservative treatment (such as feeding advice). […] Omeprazole is therefore not recommended for treating irritability, reflux or uncomplicated GORD. […] Omeprazole should only be considered in cases of severe infantile reflux oesophagitis or if GORD is causing complications such as failure to thrive. […] Between 2006 and 2010, the number of prescriptions of omeprazole dispensed for infants aged under one year in New Zealand increased from 4650 to 8231. […] This increase is despite a lack of evidence to support the prescribing of omeprazole to infants for symptoms such as irritability and regurgitation associated with uncomplicated reflux.
#32
https://bpac.org.nz/BPJ/2011/november/infant-reflux.aspx
In New Zealand, empiric treatment with omeprazole for infant irritability and reflux is increasing, despite the fact that it is not approved for this condition, is unlikely to improve symptoms and the potential adverse effects are largely unknown. […] Omeprazole should only be considered for infants in cases of gastro-oesophageal reflux disease (GORD) associated with severe reflux oesophagitis or failure to thrive. […] Uncomplicated gastric reflux is common in infants and generally resolves over time without pharmacological treatment. […] The initial diagnosis of GORD is based on symptoms and the treatment is frequently empiric, due to a lack of diagnostic tools and inability to communicate directly with the patient. […] The advantage of this approach is that the need for invasive procedures is avoided, however, using symptom severity as the diagnostic criterion for GORD can result in a significant number of cases of uncomplicated reflux being diagnosed as GORD and receiving unnecessary treatment.
#33 Reflux and GORD | The GP Infant Feeding Network (UK)
https://gpifn.org.uk/reflux-and-gord/
Distinguishing the small number of babies with pathological GORD who may benefit from treatment from the much larger number of babies with physiological GOR is a clinical challenge as many young infants have symptoms of discomfort and unsettled periods which are not caused by reflux. This diagnostic difficulty can lead to overdiagnosis causing harm from overtreatment and may make professionals doubt the existence of true pathological reflux, which in turn can lead to under-diagnosis of severe cases. […] Where GORD is suspected, a trial of treatment may be required over a time-limited period to see whether there is a pathological component. It is imperative to make treatment time-limited as many infant symptoms of discomfort and vomiting will improve spontaneously with time and treatment itself may have adverse effects.
#33 Reflux and GORD | The GP Infant Feeding Network (UK)
https://gpifn.org.uk/reflux-and-gord/
Pathological reflux (GORD) may have a more significant impact on breastfeeding. A baby who is distressed during or after feeds will be distressing for the parents and may result in a loss of confidence in breastfeeding. This can be reinforced if the baby then develops feed aversion and/or faltering growth. It is important to acknowledge parents concerns that their babies are distressed by feeds, but to reassure them that it is almost always possible to try to treat GORD without stopping breastfeeding. […] NICE Quality Standard QS112 specifies that all breastfed infants with frequent regurgitation with marked distress should have their feeding assessed, as correcting breastfeeding technique may eliminate symptoms. […] Reflux, both physiological and pathological, can be distressing for parents and unmask perinatal mental health problems. There should be a low threshold for asking about and treating these in parents of babies presenting with reflux.
#34 Medical management of gastro-esophageal reflux in healthy infants | Canadian Paediatric Society
https://cps.ca/en/documents/position/gastro-esophageal-reflux-in-healthy-infants
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 natural history of symptom resolution in GER, the limited evidence that pharmacological management of GERD in infants improves symptoms, and the serious side-effect profile of medications, all indicate that their routine use in infants who are otherwise healthy should be avoided.
#35 Nutritional Management of Gastroesophageal Reflux Among Infants in the Philippines: Insights From Real-World Evidence | Gatcheco | International Journal of Clinical Pediatrics
https://www.theijcp.org/index.php/ijcp/article/view/338/281
Gastroesophageal reflux (GER) is one of the most common digestive problems in the first months of life and decreases the quality of life in formula-fed infants. The worldwide prevalence of infantile GER is 30% with a peak of 67-87% at 2 – 4 months of life. A survey conducted in China, Malaysia, Russia and Vietnam showed that this disorder affected 61% infants aged between 0 and 3 months, 32% infants aged 3 – 6 months and 8% infants aged 6 – 12 months. […] Infantile GER is usually diagnosed using the new symptom-based Rome IV criteria for infants and toddlers. In parallel, the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) have developed an international consensus to help the pediatricians and pediatric subspecialists in the diagnosis and management of infantile GER. A joint consensus between NASPGHAN and ESPGHAN jointly recommends non-pharmacological intervention with lifestyle changes in the infants such as thickened feedings, consumption of special anti-regurgitation formulas and positioning after meals.
#36 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. […] GER is common in infants because they have a liquid diet and spend a lot of time lying down. […] If GER is more severe and longer lasting, it is called gastroesophageal reflux disease (GERD). […] If GERD isn’t treated, your baby may not eat well or gain weight. […] 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). […] Your baby’s doctor or health care provider may order medicine for GERD if lifestyle changes aren’t working. […] Surgery isn’t suggested often for babies. They will most likely outgrow GERD by the time they’re 18 months of age.
#37 Understanding Reflux in Babies | Childrenâs Health
https://www.childrens.com/health-wellness/understanding-reflux-in-babies
Reflux is the movement of the contents of the stomach all the way back up into the esophagus, the tube that connects the mouth and stomach. In some cases, the contents come out through the mouth or, more rarely, through the nose. […] Many babies have reflux for their first months of life. This reflux passes on its own and does not require treatment. If the reflux lasts longer and the baby has more severe symptoms, this is when the baby may have GERD and may need intervention. […] „Although reflux can be distressing for babies and parents, itâs important to realize that the condition will pass, and most babies with reflux will not have any long-lasting effects,” says Dr. Llanos Chea. If your baby exhibits any of the concerning reflux symptoms, make an appointment with your pediatrician.
#38 Taking a Swing at „Reflux”: Evidence-based Information From a Pediatric PT — Boost Babies, LLC
https://www.boostbabiesaustin.com/blog/2020/7/21/taking-a-swing-at-reflux-evidence-based-information-from-a-pediatric-pt
In prone, the stomach contents move towards the bottom of the stomach allowing more air to be near the junction between the esophagus and stomach decreasing reflux. Anatomically speaking, when an infant is on the left side, gas is again nearer to gastro-esophageal junction than when on the right side decreasing reflux occurrence. Left sidelying almost doubles digestion time compared to right sidelying which lowers acidity in the stomach decreasing reflux incidence and vomiting. […] Infants show the biggest decrease or least amount of reflux during sleep versus awake times. Stress hormones, (cortisol) are low during sleep. Thus, good sleep helps decrease reflux. […] While this study discourages making causation ties between the 2 diseases, the researchers emphasize the that relationship between CMT and GERD are statistically significant.
#39 Acid reflux in infants: Causes, symptoms, and treatment
https://www.medicalnewstoday.com/articles/315590
Most infants spit up milk as part of their daily activities. The action of spitting up milk is known as reflux or gastroesophageal reflux. Reflux is perfectly normal, common in infants, and is rarely serious. […] Gastroesophageal reflux (GER) happens when the contents of the stomach wash back into the baby’s food pipe. It is defined as reflux without trouble, and usually resolves itself. […] Reflux, or regurgitation, is common in infants and peaks between 3-4 months of age. Some infants regurgitate at least once a day, while some regurgitate with most feeds. […] Although more common in adults, GER can develop into gastroesophageal reflux disease (GERD). This condition may cause more troublesome symptoms and complications. […] Sometimes reflux in infants might be caused by a more serious condition, such as: Food intolerance, Eosinophilic esophagitis, Pyloric stenosis, GERD.
#40 Development of an infant stomach model: validation of products targeting reflux in neonates and infants – Fisher – Annals of Esophagus
https://aoe.amegroups.org/article/view/5834/html
Gastroesophageal reflux can affect 50% of infants younger than three months old (1). […] The epidemiology of GER in the infant is interesting with regurgitation common and occurring at least once daily in 50% in infants up to three months of age. The prevalence of regurgitation peaks at four months of age with around 70% of infants regurgitating at least once daily (16). […] Neonate and infant GER is a growing market sector and the development of new products treating GER in neonates and infants is important and especially appropriate when GER changes from simply being mild and physiological to becoming pathological due to an increase in frequency and severity of reflux episodes. This can lead to insufficient caloric intake and a slowing of growth in the infant. […] There are no infant stomach models currently available for screening new potential feed thickening products for suppressing reflux in neonate and infants. […] The successful development of the Infant Stomach model has allowed for a well validated working model for screening new treatments for GER in neonates and infants.
#41 Nutritional Management of Gastroesophageal Reflux Among Infants in the Philippines: Insights From Real-World Evidence | Gatcheco | International Journal of Clinical Pediatrics
https://www.theijcp.org/index.php/ijcp/article/view/338/281
This survey revealed that GER-related symptoms such as regurgitation still occur among infants aged 7 – 12 months (31% of all infants). Generally, GER peaks at the age of 2 – 4 months and should resolve by 12 months of age. […] To conclude, this survey investigated the clinical course of Filipino infants suffering from infantile GER, after changing to a special infant formula designed to relieve GER. A formula designed for management of regurgitation and thickened with CBG, GOS and PHW effectively improved regurgitation symptoms and patients quality of life within the 14 days of consumption. Underlying conditions among infants who still had symptoms after 14 days need to be investigated, especially that prolonged symptoms of functional gastrointestinal disorders in early life could lead to increased risk of these disorders in later life.
#42 Gastro-Esophageal Reflux in Children
https://www.mdpi.com/1422-0067/18/8/1671
Gastro-esophageal reflux (GER) is common in infants and children and has a varied clinical presentation: from infants with innocent regurgitation to infants and children with severe esophageal and extra-esophageal complications that define pathological gastro-esophageal reflux disease (GERD). […] Understanding the natural history and outcomes of GERD in children is very important to identify patients at risk of GERD-related complications and the persistence of symptoms into the adulthood. […] The passage of gastric content into the esophagus (i.e., GER) is a normal phenomenon occurring many times a day, in both adults and children. Infants are especially prone to regurgitate and it has been shown that the number of infants with this phenomenon decreases from about 80% during the first month of life to less than 10% at the age of one year.