Materiały źródłowe

• #1 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.

• #1 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 gets better on its own in most babies (9 out of 10) by the time they are 1 year old. […] The healthcare professional should talk with you about reflux and how common it is, give you advice and reassure you about it. This is because, for most babies, regurgitating feeds is completely normal and will disappear as the baby gets older.

• #1 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%.

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

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

  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.

• #1 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. […] 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. […] The prevalence of GERD was recently estimated at 26.9% (95% CI 20.133.7) in a meta-analysis of 4 studies comprising infants from birth to 3 years. […] The peak prevalence of infant GERD was at 6 weeks, which is consistent with other Asian populations. […] This study provides data on the epidemiology, risk factors, longitudinal course and social impact of GERD in an Asian paediatric population. […] There is currently a paucity of data on GERD prevalence in Asian infants and much of the published literature is based on adults or children in Western populations. […] This study utilised a robust, validated questionnaire-based tool, the I-GERQ-R, to evaluate not only the prevalence but also the natural history of GERD longitudinally across the first 12 months of life in Asian infants.

• #1 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. […] 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.

• #1 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.

• #1 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. […] A higher prevalence of GERD is present in children who have the following: a history of esophageal atresia with repair; neurologic impairment and delay; hiatal hernia; bronchopulmonary dysplasia; asthma; and chronic cough. […] After the first year of life, GERD is more resistant to complete resolution. […] 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.

• #1 Natural history of gastroesophageal reflux in infancy: new data from a prospective cohort

  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7137340/

  The rate of exclusive breastfeeding was 49% at 1 month, 31% at 3 months and 9% at 10 months of age. […] 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. I-GERQ-R is useful for clinical screening and follow up of GER and GERD.

• #1 Gastro-oesophageal reflux: a mixed methods study of infants admitted to hospital in the first 12 months following birth in NSW (2000–2011) | BMC Pediatrics | Full Text

  https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-018-0999-9

  In the review of 326 medical records we found 36% of infants were reported to have GOR/GORD on admission to the RPS. The rate was 32% in the Tresillian RPS (n=220) and 43% in the Karitane RPS (n=106). […] 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.

• #1 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.

• #1 Gastro-oesophageal reflux: a mixed methods study of infants admitted to hospital in the first 12 months following birth in NSW (2000–2011) | 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). […] Determination of the exact prevalence of GOR versus GORD is challenging because there is unclear demarcation between physiologic and pathologic reflux and incidence and prevalence data. […] In infants 4 to 6 months of age, the prevalence of GOR has been estimated as affecting 23% to 29% of infants in Italy, USA and Japan and 41% in Australia. Preterm and low birth weight infants are said to be at particularly high risk of developing GORD with the overall incidence estimated between 30 and 50% linked to the immaturity of the oesophagus and stomach.

• #1 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. Current recommendations to manage GERD include feeding modifications such as thickening feeds, or avoiding cows milk protein. There is limited evidence for pharmacological management, including acid suppressive therapy or prokinetic agents, with the risks of such treatments often outweighing possible benefits due to significant safety and side effect concerns. Acid-suppressive therapy should not be routinely used for infants with GERD and is most likely to be useful in the context of symptoms that suggest erosive esophagitis. Evidence for managing symptoms attributed to GERD in otherwise healthy term infants less than one year of age is presented, and the over-prescription of medications in this population is discouraged. Anticipatory guidance regarding the natural resolution of reflux symptoms is recommended.

• #1 Medical management of gastro-esophageal reflux in healthy infants | Canadian Paediatric Society

  https://cps.ca/en/documents/position/gastro-esophageal-reflux-in-healthy-infants

  Gastroesophageal reflux disease (GERD) occurs when GER leads to symptoms that affect daily functioning or to complications. This definition is problematic in infants because many symptoms attributed to GERD are non-specific. The incorrect attribution of symptoms leads to frequent overtreatment of GERD by physicians. […] 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.

• #1 Gastroesophageal Reflux in Infants and Children | AAFP

  https://www.aafp.org/pubs/afp/issues/2001/1201/p1853.html

  In most cases of GER, no diagnostic study is required. […] No single definitive study can diagnose GERD. […] 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. […] 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.

• #1 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 […] Gastro-oesophageal reflux disease (GORD) should be differentiated from physiological gastro-oesophageal reflux, which is common in healthy, thriving babies and does not require specific investigations or management […] 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

• #1 About this Site

  https://depts.washington.edu/growing/Feed/GER.htm

  Gastroesophageal reflux (GER) and/or aspiration risk appears to be higher in VLBW and LBW infants. […] It appears reasonable to screen each LBW infant frequently in the first months of life to rule out need for further assessment for GER and/or aspiration. […] If infant behaviors, growth, and parental report seem to indicate that reflux in an infant is pathological, further investigation is warranted. […] The pH probe is considered the „gold standard” for diagnosis of GER. […] The use of feedings thickened with cereal may reduce the episodes of regurgitant reflux but non-regurgitant reflux and attendant problems may still occur. […] Nevertheless, many parents report that adding cereal to infant feedings is effective.

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

  https://pghn.org/DOIx.php?id=10.5223/pghn.2021.24.3.256

  However, few studies have assessed the association between GER and apnea/BRUE in small infants. […] This study demonstrated that only MII-pH monitoring can be used to assess whether BRUE is associated with GER. […] Among infants experiencing BRUE, MII-pH monitoring revealed more than 100 GER episodes in almost half of the patients. Most of these GER episodes were non-acid and weakly acidic, which is consistent with previous studies that showed an association between non-acid GER and acute events. […] If only pH-metry was used, diagnosis would be missed in the majority of children with BRUE induced by GER because none of the non-acid and weakly acid reflux episodes would have been registered. […] Our study confirmed that in infants, weakly acidic reflux precedes BRUE more frequently than acidic reflux.

• #1 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. […] The following approach is a generalization that, like all generalizations, may need to be modified for an individual patient. First, interest is focused on uncomplicated GER, mostly restricted to regurgitating infants. In a second paragraph, a proposal is made for optimal management in patients with complicated GER disease (symptoms suggestive of esophagitis). […] Infants with typical symptoms of uncomplicated GER (the majority of regurgitating babies) should be treated without prior investigations. Endoscopy, in specialized centers, is recommended if esophagitis is suspected. Long-term esophageal pH monitoring is the investigation of choice and occupies a central position in the diagnostic approach of the patient suspected of unusual or atypical presentations of GER-disease (occult GER-disease). […] Management of GER (-disease) in infants and children should therefore be well overthought, avoiding overinvestigations and overtreatment of a self-limiting condition, but also avoiding underestimation of potential severe disease, accompanied by serious morbidity.

• #1 The comparative analyses of different diagnostic approaches in detection of gastroesophageal reflux disease in children | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0187081

  The aim of this study was to compare the different diagnostic approaches in detection of gastroesophageal reflux disease in children presented with symptoms suggesting gastroesophageal reflux disease. […] A total of 218 (117 boys/101 girls), mean age 6.7 years (range 0.0618.0 years), met the inclusion criteria. Gastroesophageal reflux disease was found in 128 of 218 children (57.4%) by pH-MII and in 76 (34.1%) children by pH metry alone. […] The results of our study suggested that compared with pH-metry alone, pH-MII had significantly higher detection rate of gastroesophageal reflux disease, especially in infants. Our findings also showed that pH-MII parameters correlated significantly with the endoscopically confirmed erosive esophagitis. […] The sensitivity of pH-metry alone in children with extraesophageal symptoms was 38.1%, while the sensitivity of pH-metry in children with gastrointestinal symptoms was 63.8%.

• #1 The comparative analyses of different diagnostic approaches in detection of gastroesophageal reflux disease in children | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0187081

  Logistic regression analysis showed that best predictors of endoscopic reflux esophagitis are the longest acid episode (OR = 1.52, p0.05) and DeMeester reflux composite score (OR = 3.31, p0.05). […] The significant cutoff values included DeMeester reflux composite score 29 (AUC 0.786, CI 0.6950.877, p0.01) and duration of longest acid reflux 18 minutes (AUC 0.784, CI 0.6920.875, p0.01).

• #1

  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.

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

  https://pghn.org/DOIx.php?id=10.5223/pghn.2021.24.3.256

  Data on the relationship between gastroesophageal reflux (GER) and brief resolved unexplained events (BRUE) in infants is scarce. The aim of this study was to identify the characteristics of combined multichannel intraluminal impedance-pH (MII-pH) monitoring in infants who have experienced BRUE. […] Gastroesophageal reflux (GER) is common in preterm and term infants. Harmful consequences of GER, called GER disease (GERD), have been associated with different manifestations such as obstructive apnea, oxygen desaturation, stridor, and wheezing. […] BRUE symptoms associated with GER were found in 10 infants (47.6%). […] Both acid and non-acid reflux seem to play a significant role in the pathogenesis of GER-related BRUE in infants. […] In neonates and small infants, nonacid GER, rather than acidic GER, plays a major role in causing the symptoms.

• #1 Acid Gastroesophageal Reflux in Convalescent Preterm Infants: Effect of Posture and Relationship to Apnea | Pediatric Research

  https://www.nature.com/articles/pr2007289

  Concerns regarding gastroesophageal reflux (GER) and associated apnea episodes result in some practitioners having convalescent, prematurely born infants sleep in the prone position. […] Supine compared with prone sleeping neither increases clinically important acid GER nor obstructive apnea episodes associated with acid GER in asymptomatic, convalescent, prematurely born infants. […] We have demonstrated that, in asymptomatic, convalescent, prematurely born infants, acid GER was more common in the supine rather than the prone position. […] In addition, no significant association of acid reflux with obstructive or total apnea episodes was found. […] We now demonstrate sleeping in the supine compared with prone position neither increases acid GER nor apnea episodes associated with acid GER in asymptomatic, convalescent, prematurely born infants.

• #1 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.

• #1

  https://www.healthychildren.org/English/health-issues/conditions/abdominal/Pages/GERD-Reflux.aspx

  GER in infants is not considered a disease (so it does not include a „D”). In fact, it is considered normal. […] 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 pediatrician may refer your child to see a pediatric gastroenterologist, a pediatrician who has specialized training in problems of the gastrointestinal tractincluding GERDfor a variety of reasons.

• #1 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. […] Gastro-oesophageal reflux is very common (it affects at least 40% of infants); it usually begins before the infant is eight weeks old; may be frequent (5% of those affected have 6 or more episodes each day); usually becomes less frequent with time (it resolves in 90% of affected infants before they are 1 year old); does not usually need further investigation or 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.

• #1 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

  There are no infant stomach models currently available for screening new potential feed thickening products for suppressing reflux in neonate and infants. Any such model needs to be robust, reproducible and to be physiologically relevant. Such a model is described here along with the achievement of a full model validation demonstrating not only the models robustness and reproducibility but also the functionality of feed thickener agents. […] 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. The model opens new opportunities in product development for this sector.

• #1 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 (GER) 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). Regurgitation declines precipitously dropping to 14% by seven months of age and to less than 5% between 10 and 14 months of age (17). During year two a further decline in regurgitation is reported (18). […] 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. The bigger concern is as the infant gets older the frequency of the GER can lead to more serious diseases later in life.

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

  https://www.medicalindependent.ie/update/update-gastroenterology/infant-gord-and-refluxdiagnosis-and-management-2/

  Epidemiological data indicates that reflux is prevalent, affecting around 50 per cent of infants under two months, increasing to 60-to-70 per cent in infants aged three-to-four months, and declining to 5 per cent by the age of 12 months. […] Pre-term infants face an increased risk of reflux due to the physiological immaturity of the LOS, impaired oesophageal peristalsis, relatively abundant milk intake, and slower gastric emptying. The estimated incidence of reflux in infants born before 34 weeks of gestation is approximately 22 per cent. […] GORD is more prevalent in children with obesity, neurological impairment, congenital heart disease, abnormalities of the GI tract, congenital diaphragmatic hernia, and chromosomal abnormalities. Obesity is an important predisposing factor, and is associated with increased transient relaxation of the LOS and higher intra-gastric pressure. […] There is an increased concordance of reflux in monozygotic twins compared with dizygotic twins, suggesting genetic factors might have a role to play in the aetiology.

• #2 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. […] Gastro-oesophageal reflux is very common (it affects at least 40% of infants); it usually begins before the infant is eight weeks old; may be frequent (5% of those affected have 6 or more episodes each day); usually becomes less frequent with time (it resolves in 90% of affected infants before they are 1 year old); does not usually need further investigation or 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.

• #2 Medical management of gastro-esophageal reflux in healthy infants | Canadian Paediatric Society

  https://cps.ca/en/documents/position/gastro-esophageal-reflux-in-healthy-infants

  Gastroesophageal reflux disease (GERD) occurs when GER leads to symptoms that affect daily functioning or to complications. This definition is problematic in infants because many symptoms attributed to GERD are non-specific. The incorrect attribution of symptoms leads to frequent overtreatment of GERD by physicians. […] 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.

• #2 The comparative analyses of different diagnostic approaches in detection of gastroesophageal reflux disease in children | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0187081

  The aim of this study was to compare the different diagnostic approaches in detection of gastroesophageal reflux disease in children presented with symptoms suggesting gastroesophageal reflux disease. […] A total of 218 (117 boys/101 girls), mean age 6.7 years (range 0.0618.0 years), met the inclusion criteria. Gastroesophageal reflux disease was found in 128 of 218 children (57.4%) by pH-MII and in 76 (34.1%) children by pH metry alone. […] The results of our study suggested that compared with pH-metry alone, pH-MII had significantly higher detection rate of gastroesophageal reflux disease, especially in infants. Our findings also showed that pH-MII parameters correlated significantly with the endoscopically confirmed erosive esophagitis. […] The sensitivity of pH-metry alone in children with extraesophageal symptoms was 38.1%, while the sensitivity of pH-metry in children with gastrointestinal symptoms was 63.8%.

• #2 Gastro-oesophageal reflux: a mixed methods study of infants admitted to hospital in the first 12 months following birth in NSW (2000–2011) | BMC Pediatrics | Full Text

  https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-018-0999-9

  In the review of 326 medical records we found 36% of infants were reported to have GOR/GORD on admission to the RPS. The rate was 32% in the Tresillian RPS (n=220) and 43% in the Karitane RPS (n=106). […] 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.

• #3 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. […] The following conditions raise the risk of experiencing infant GERD: Hiatal hernia, Neurodevelopmental disorders, Cystic fibrosis, Epilepsy, Congenital food pipe disorders, Asthma, Premature birth, Obesity, Parent history of reflux. […] 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. […] Most cases of regurgitation or reflux resolve within the baby’s first year and require no treatment. […] Infants tend to outgrow regurgitation as the lower esophageal sphincter strengthens. Most cases GER will disappear by 18 months of age or earlier.

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