Materiały źródłowe

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

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

  Gastroesophageal reflux in infants may be treated with body position changes while awake, lower-volume feedings, thickening agents (i.e., rice cereal), antiregurgitant formula, extensively hydrolyzed or amino acid formulas, and, in breastfed infants, eliminating cow’s milk and eggs from the mother’s diet. […] Conservative treatments are the first-line strategies for most infants, older children, and adolescents with reflux and GERD. […] A trial of extensively hydrolyzed or amino acid formula in formula-fed infants, or maternal dietary modification in breastfed infants, is warranted when reflux is presumed to be caused by an allergy to cow’s milk protein. […] Histamine H2 receptor antagonists are an option for acid suppression therapy in infants and children with GERD. […] Proton pump inhibitors are reasonable treatment options for GERD in older children and adolescents, but their use in infants is questionable because of a lack of proven effectiveness.

• #2 Reflux in Babies: Signs & Treatment

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

  Treatment for your babys reflux depends on its severity. Babies with GER dont need medications. Instead, they may benefit from changes to their feeding routine. Such changes can also help babies with GERD, but these babies sometimes need medications. Rarely, babies with GERD need surgery. […] Possible treatments include: […] Medications. Healthcare providers only prescribe medications for babies who clearly have GERD, and even then, only in select cases. Medications like proton pump inhibitors (PPIs), can help manage complications of GERD, like inflammation in your babys esophagus (esophagitis). But they come with risks and side effects, so providers use them only when necessary and for as short a time as possible. […] Surgery. If other measures arent enough to treat GERD or its complications, surgery may be an option. A pediatric gastroenterologist can tell you more about surgical options, including laparoscopic Nissen fundoplication. Providers consider surgery in infants only in select cases.

• #3 Treatment for GER & GERD in Infants – NIDDK

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

  Most infants with GER do not need treatment. GER symptoms typically improve on their own by the time a child is 12 to 14 months old. Depending on an infants age and symptoms, doctors may recommend lifestyle changes to treat GER or GERD symptoms. […] Doctors may recommend lifestyle changes to help improve symptoms of GER or GERD in infants. […] Doctors may recommend medicines typically proton pump inhibitors (PPIs) or H2 blockers if an infant has esophagitis or has bothersome GERD symptoms that don’t improve after lifestyle changes. […] Doctors don’t often recommend surgery to treat GERD in infants. Doctors may recommend surgery if an infant’s symptoms are severe and other treatments don’t help or if an infant has serious GERD complications.

• #4 Treatment of GE Reflux – Department of Pediatrics

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

  The most important thing to remember when treating gastroesophageal (GE) reflux is that in almost all cases, the problem will get better on its own! […] Given enough time, the baby will fix the problem on his or her own. […] Treatments for reflux can be summarized in categories: positioning, dietary treatments, changing feeding schedules, medications, surgery. […] Theoretically, the best position to but a baby with reflux in after meals is lying on the stomach with the head propped up about 30 degrees. […] Young infants don’t have much control of their abdominal or chest muscles, so when placed in an infant seat or swing, they tend to slump down. […] Parents may be instructed to thicken infant feedings with cereal. […] Many parents find that their babies keep solid foods down more effectively than liquids.

• #5 Patient education: Acid reflux (gastroesophageal reflux) in babies (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/acid-reflux-gastroesophageal-reflux-in-babies-beyond-the-basics

  Patient education: Acid reflux (gastroesophageal reflux) in babies (Beyond the Basics) […] This article discusses the symptoms, causes, diagnosis, and treatment of babies with GER and GERD. […] TREATMENT […] General measures for all babies — Babies with uncomplicated reflux („happy spitters”) do not require treatment. However, the following measures are appropriate for all babies and may help to improve the reflux symptoms, in addition to other benefits: […] Positioning — It might help to keep your baby upright and calm for 20 to 30 minutes after a feed. […] Trials of dietary changes — If the reflux is still a problem after trying the above measures, you can try thickened feeds or a milk-free diet. […] Medicines — Medications are not recommended for most babies with reflux, because: […] If your baby has concerning symptoms that might be related to acid reflux, such as severe irritability, feeding refusal, or poor weight gain, talk to their health care provider.

• #6 Pediatric Gastroesophageal Reflux Treatment & Management: Approach Considerations, Positioning, Dietary Measures

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

  Conservative measures in treating gastroesophageal reflux may include upright positioning after feeding, elevating the head of the bed, prone positioning (infants 6mo), and providing small, frequent feeds thickened with cereal. […] In more severe cases, in addition to dietary management, pharmacologic intervention directed at reducing gastric acid secretion can be employed. […] Results of medical therapy are generally met with a better long-term response, leading to elimination of antisecretory medications (when prescribed) during infancy. […] According to the guidelines of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition, infants with uncomplicated physiologic GER should be treated not with medication but with modest lifestyle changes; medications should be reserved for infants with GERD.

• #7 Treating Acid Reflux in Infants

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

  If your baby is spitting up and exhibiting any of the following symptoms, it could be a sign of a condition known as GERD. This is the medical term for ongoing acid reflux. […] The options for treating acid reflux in your baby depend on their age and severity. Lifestyle changes and home care can sometimes work well, but always keep your babys doctor informed. […] If you think your baby is experiencing acid reflux, you can try these home remedies and adjustments. […] Your baby may be more likely to have reflux and spit up when their stomach is too full. Having smaller feedings more often can help with this. […] If youre nursing, your baby may benefit from a change in your diet. […] If you can, feed your baby in the upright position and keep it for about 30 minutes after feeding. This can prevent stomach acids from creeping up.

• #8 Treatment of GE Reflux – Department of Pediatrics

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

  Parents are sometimes instructed to feed their babies smaller amounts more often with the idea that over-feeding tends to make reflux worse. […] Most medications used to treat reflux fall into three groups based on how they work: break down or lessen intestinal gas, decrease or neutralize stomach acid, improve intestinal coordination. […] It is assumed that decreasing the amount of stomach acid will lessen reflux symptoms. […] For the most part, medicines that decrease intestinal gas or neutralize stomach acid (antacids) are very safe. […] Medications that improve intestinal coordination: Reglan, Propulcid, erythromycin. […] It is extremely rare for children with GE reflux to require surgery. […] The most commonly performed operation is the Nissen fundoplication. […] This operation is very effective at eliminating GE reflux, with long-term success rates approaching 90%.

• #9 Treating Acid Reflux in Infants

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

  If possible, try to avoid a sleep positioner while feeding or sleeping. […] If you bottle feed, keep the nipple filled with milk throughout the feedings to avoid air gulping. […] With your pediatricians approval, adding a small amount of baby cereal to formula or breast milk may be an option to lessen spitting up. […] Whether youre nursing or bottle-feeding, make sure to frequently burp your baby. Burping your infant during a feeding may help with reflux symptoms. […] Always put your baby to sleep on their back on a firm mattress. […] Speak to your babys pediatrician if you want to use natural remedies to treat your childs reflux. You will want to make sure that you choose safe and proven remedies. […] If lifestyle changes dont help, your pediatrician may recommend further investigation into other causes of your babys symptoms, such as GERD.

• #10 Pediatric Gastroesophageal Reflux Treatment & Management: Approach Considerations, Positioning, Dietary Measures

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

  The most aggressive treatments, including surgery, should be reserved for children who have intractable symptoms or are at risk for life-threatening complications. […] Surgery is required in only a very small minority of patients with gastroesophageal reflux. […] For patients who fail medical therapy, continuous intragastric administration of feeds alone (via nasogastric tube) may be used as an alternative to surgery. […] Thickening an infant’s formula provides a therapeutic advantage against gastroesophageal reflux, particularly when excessive vomiting is associated with suboptimal weight gain. […] Research suggests that formula thickening is superior to positioning in promoting weight gain and reducing clinical symptoms in infants with gastroesophageal reflux. […] Guidelines from the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) discuss the use of step-up and step-down therapies, which should be instituted under the guidance of a pediatric gastroenterologist.

• #11 Reflux in babies

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

  A GP or specialist may sometimes recommend treatments for reflux. […] If your baby is formula-fed, you may be given: a powder that’s mixed with formula to thicken it, a pre-thickened formula milk. […] If the thickening powder does not help or your baby is breastfed, a GP or specialist might recommend medicines that stop your baby’s stomach producing as much acid. […] Very rarely, surgery might be needed to strengthen the muscles to stop food or milk travelling back up. This is usually only after trying other things or if their reflux is severe.

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

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

  Non-pharmacological therapies to be considered for healthy infants with suspected GERD include thickened feeds, avoiding cows milk protein, and infant positioning. […] Evidence for thickened feeds was summarized in a systematic review that included 14 randomized controlled trials (RCTs) comparing thickened with regular feeds. Thickened feeds did not improve acidity scores measured via pH-probe. They did decrease the daily number of episodes of vomiting and regurgitation, and weight gain improved in four studies. The impact of thickened feeds on other symptoms attributed to GERD, such as crying or fussiness, is unclear. Recent international guidelines state that a 2-week trial of thickened feeds may be attempted for infants with GERD who display significant vomiting. […] Avoiding cows milk does not treat GERD, although a subset of children who have cows milk protein allergy may experience symptoms similar to GERD and could benefit from this approach. Symptoms in these children will usually improve within 2 weeks of cows milk protein removal, and re-introduction typically results in symptom return. A 2- to 4-week trial of cows milk protein avoidance can be tried when other non-pharmacological measures to treat symptoms attributed to GERD have failed.

• #13 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

  Check your sources. So many people have experience with reflux; however, their advice is not always based in science and might not be the best course of treatment for your child. Promote safe sleep – the AAP emphasizes that elevating the infants head during supine sleep is NOT recommended and prioritizes safety due to the possibility of the infant rolling and compromising respiration. Extensive use of seating positions like swings, bouncers, and car seats exacerbates reflux and even limits infant exposure to various movements to achieve optimal gross motor development. Positions like prone with head elevation and left-sidelying may decrease reflux occurrence during awake times. Increasing feeding frequency and decreasing feeding volume reduces reflux occurrence. There is a correlation between infants with GERD and Torticollis. This is NOT causation, but as clinicians, we need to be aware of the significance of this relationship during our treatments.

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

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

  For infants, children, and adolescents with GERD that does not improve with conservative treatment, an empiric four-week trial can be considered using acid suppression therapy with histamine H2 receptor antagonists or proton pump inhibitors (PPIs). […] H2 antagonists decrease acid secretion by inhibiting H2 receptors on gastric parietal cells. […] PPIs block sodium-potassium adenosinetriphosphatase (Na+,K+-ATPase) enzyme activity, which is the final step in parietal cell acid secretion. […] Surgical options are available and should be considered in children with complications from severe GERD if medical therapy is unsuccessful or is not tolerated.

• #15 Infant reflux | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/infant-reflux

  For most babies, making some changes to feeding eases infant reflux until it gets better on its own. […] 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. Acid-blocking medicines include cimetidine (Tagamet HB), famotidine (Pepcid AC) and omeprazole magnesium (Prilosec). Your child’s health professional may recommend an acid-blocking medicine if your baby: […] 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.

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

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

  Small studies have suggested that left lateral positioning or head elevation after feeding may improve acid reflux parameters measured by pH probe. However, there is little evidence either way for assessing whether infant positioning improves symptoms attributed to GERD. […] Pharmacological agents to treat GERD in infants include acid-suppressive medications (H2 receptor antagonists (H2RAs), proton pump inhibitors (PPIs)) and prokinetics. […] Data supporting the efficacy of H2RAs for infants with GERD symptoms are limited. While the endoscopic evaluation of infants with esophagitis who have been treated with H2RAs appears to show histological improvement, it remains uncertain whether H2RAs can improve symptoms of GERD, such as crying and fussiness, when compared with placebo or PPIs. […] Several systematic reviews have assessed the effectiveness of PPIs in relieving GERD symptoms in infants. PPIs decrease acid secretion in the stomach, but it remains unclear whether they have any effect in reducing symptoms, compared with placebo, hydrolyzed formula, or H2RAs.

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

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

  In keeping with recent international recommendations and a CPS recommendation made for the Choosing Wisely Canada campaign in 2017, acid-suppressive therapy should not be routinely used for the treatment of crying, fussing, arching, or regurgitation in otherwise well infants. There is no evidence that these medications improve GERD symptoms in infants, and their side-effect profile is significant. Because the natural history of GERD symptoms is to resolve over time, trials of therapy with acid-suppressive agents to establish a diagnosis of GERD are not recommended. […] Scant evidence to support the efficacy of prokinetics and accumulating evidence for their significant negative side-effects both indicate they should not be used routinely to treat otherwise healthy infants with symptoms of GERD.

• #18 Infant reflux | Better Health Channel

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

  Reflux medications do not improve crying in most babies. […] In babies with GORD, your doctor might prescribe medication to help treat these symptoms. […] If your baby has reflux, but not GORD, there are no medications that can help. […] Babies with GORD are sometimes given medications to help reduce stomach acid. […] As with any medication, there are potential risks and side effects for babies. […] Taking medications for GORD means that babies may be at risk of the following compared to babies who do not take these medications: 3 to 6 times more likely to develop gastroenteritis (gastro) and pneumonia. […] Although there are no medications available, these strategies may help: Remember, if your baby is vomiting but is otherwise happy and growing well, there is no need to worry.

• #19 Gastrooesophageal reflux disease in infants

  https://www.rch.org.au/clinicalguide/guideline_index/Gastrooesophageal_reflux_disease_in_infants/

  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. […] Empiric use of acid suppression for unsettled infants is not effective and may cause harm. […] The natural history of GORD is of resolution with time; any therapy commenced should be reviewed regularly. […] Simple GOR can cause considerable parental distress, and requires reassurance, support and anticipatory guidance. General measures may minimize symptoms. […] Holding the infant in a head elevated position for 20-30 minutes after feeding may reduce GOR. […] In bottle fed babies, thickened feeds may reduce frequency of vomiting. […] Acid suppressant therapy may be indicated in specific patients with GORD.

• #20 Gastrooesophageal reflux disease in infants

  https://www.rch.org.au/clinicalguide/guideline_index/Gastrooesophageal_reflux_disease_in_infants/

  When commenced, it should be instituted as a four week trial. […] Studies have indicated that PPI therapy may lead to an increased risk of community acquired pneumonia, increased risk of gastroenteritis, increased future fracture risk, and micronutrient deficiencies. […] It is important to review ongoing therapy and cease at 4 weeks if no benefit. […] Surgical approaches (eg fundoplication) are reserved for children who have intractable GORD symptoms unresponsive to medical therapy or with significant complications.

• #21 Pediatric Gastroesophageal Reflux: Practice Essentials, Background, Etiology and Pathophysiology

  https://emedicine.medscape.com/article/936596-treatment

  The following medications are used in pediatric patients with gastroesophageal reflux disease: Antacids, Histamine H2 antagonists, Proton pump inhibitors. […] Surgical intervention such as gastrostomy or fundoplication is required in only a very small minority of patients with gastroesophageal reflux (eg, when rigorous medical step-up therapy has failed or when the complications of gastroesophageal reflux pose a short- or long-term survival risk). The goal of surgical antireflux procedures is to „tighten” the region of the lower esophageal junction and, if possible, to reduce hiatal herniation of the stomach.

• #22 GERD in Children | Treatment for Acid Reflux in Kids | GI Care for Kids

  https://www.gicareforkids.com/conditions-we-treat/gastroesophageal-reflux-disease-gerd/

  Avoid GERD medications such as H2-blockers or proton pump inhibitors for crying, distress, or visible regurgitation in otherwise healthy and strong infants. […] For the older child: Conduct a four- to eight-week trial using proton pump inhibitor medication. […] Common medications used to treat GERD in children include: Antacids and alginates – Medications designed to neutralize acid and relieve symptoms such as heartburn or dyspepsia. […] Surgical approaches to decrease acid reflux are usually undertaken only after all other options have failed. […] Fundoplication may be appropriate for infants and children with GERD if: Life-threatening complications like cardiorespiratory failure exist after more conventional treatment methods have failed.

• #23 Gastro-oesophageal reflux | Great Ormond Street Hospital

  https://www.gosh.nhs.uk/conditions-and-treatments/conditions-we-treat/gastro-oesophageal-reflux/

  How is gastro-oesophageal reflux treated? Initially, the childs feeds and feeding pattern may be adjusted to see if that improves the symptoms. For instance, feeding smaller amounts more frequently will be suggested along with changes to their feeding position, such as sitting them in a more upright position during feeds and immediately afterwards. […] Medications may also be suggested some form a barrier on top of the stomach contents to reduce the risk of them flowing backwards, while others damp down acid production in the stomach. Another type of medication speeds up the rate at which feed passes from the stomach into the duodenum and intestines. All these medications take some time to work but can be very helpful for the majority of children. […] If a child has severe gastro-oesophageal reflux which is not controlled with medication or is causing significant complications, your doctor may recommend an operation called a fundoplication to prevent reflux. Before reaching this decision, the severity of the childs reflux will usually be assessed with an upper GI contrast study and a pH or impedance study. As every child is different, the decision to recommend surgery will only be made after these assessments have been completed. The fundoplication operation uses the top of the stomach to strengthen the sphincter so it is less likely to allow food, drink or acid to travel back into the foodpipe.

• #24 Pediatric Gastroesophageal Reflux: Practice Essentials, Background, Etiology and Pathophysiology

  https://emedicine.medscape.com/article/936596-treatment

  In pediatric gastroesophageal reflux disease (GERD), immaturity of lower esophageal sphincter function is manifested by frequent transient lower esophageal relaxations, which result in retrograde flow of gastric contents into the esophagus. […] The goals of medical therapy in gastroesophageal reflux are to decrease acid secretion and, in many cases, to reduce gastric emptying time. […] Conservative measures in treating children with gastroesophageal reflux include the following: Providing small, frequent feeds thickened with cereal, Upright positioning after feeding, Elevating the head of the bed, Prone positioning (infants 6 months). […] For patients who fail medical therapy, continuous intragastric administration of feeds alone (via nasogastric tube) may be used as an alternative to surgery.

• #25 Helping Babies with Reflux Beyond Medications — Progress Through Play

  https://www.ptpdenver.com/blog/helping-babies-with-reflux-beyond-medications

  Ten years ago, I was that mom. I had an inconsolable, uncomfortable baby who seemed trapped in a cycle of reflux medications with little to no lasting improvement. […] Medications can be helpful in certain cases, but the interventions shouldn’t stop there. […] A skilled International Board Certified Lactation Consultant (IBCLC) is extremely valuable in assessing feeding patterns and ensuring your baby is getting the nourishment they need without discomfort. […] Sometimes, reflux symptoms are tied to feeding difficulties, and an IBCLC can provide strategies and solutions to make feeding easier and less stressful for both baby and parent. […] A comprehensive oral functional assessment, performed by a pediatric therapist trained in oral motor therapy, can identify tongue ties, poor suck-swallow coordination, and other oral dysfunctions.

• #26 Helping Babies with Reflux Beyond Medications — Progress Through Play

  https://www.ptpdenver.com/blog/helping-babies-with-reflux-beyond-medications

  Addressing these issues early can significantly improve feeding efficiency and reduce reflux. […] Manual therapies, such as gentle infant massage, myofascial release or craniosacral therapy, help reduce this tension, allowing the baby to feel more comfortable in their body. […] A referral to a pediatric gastroenterologist or nutritionist can help determine if your baby has any specific dietary needs or allergies that are contributing to their symptoms. […] A tailored home program that includes specific positions and gentle exercises can reduce discomfort and help your baby learn to self-soothe. […] By working with a multidisciplinary team including a lactation consultant, infant therapist, manual therapy specialist, and possibly a GI expert, you can address the root causes of your baby’s discomfort and create lasting improvements. […] Reflux doesn’t have to take over your life – there is hope, and there are solutions.

• #27

  https://chiroformoms.com/blogs/kidz-techniques/reflux?srsltid=AfmBOorfF7TRUmX1r-paVk0CRAx7mxnrh0helw4SuEDS-nMwTjMgSM_L

  Watch our simple natural remedies for acid reflux in babies! As pediatric chiropractors, we treat acid reflux and silent reflux every day. Learn our favorite stretches and natural reflux techniques that we use in office and you can try at home. […] When treating reflux, our pediatric providers focus on bodywork + stretching that directly impacts the anatomy of the condition. This always involves relaxing the diaphragm, massaging the abdomen to create space for the contents to settle, for the relief of gas / air in the gastrointestinal tract. Try these techniques prior to baby feeding! […] Massaging the diaphragm creates space in the lower esophagus and the stomach to help relieve acid reflux naturally. […] Utilizing a football hold for babies is a great way to implement many of our favorite stretches and natural techniques! The reflux remedy specifically places the baby’s left side down. Left side-lying places allows gravity to help the stomach keep it’s contents, helping acid reflux in babies!

• #28

  https://chiroformoms.com/blogs/kidz-techniques/reflux?srsltid=AfmBOorfF7TRUmX1r-paVk0CRAx7mxnrh0helw4SuEDS-nMwTjMgSM_L

  The final technique also focuses on the diaphragm, but in a prone [tummy down] position. You can apply gentle upward pressure below the middle of the rib cage and massage outward. Tummy time is a great position to utilize for babies with reflux! The pressure on the tummy typically feels good, and it allows for the tense tissues/fascia to relax. […] Tongue and Lip ties are often key causes of both colic and reflux.

• #29 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. 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. With that said, Im going to take a scientific swing at this popular topic of reflux and hopefully shed some light on some non-pharmacological interventions that may impact your child. […] Feeding volume and frequency impacts reflux among 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. […] Positioning and stomach orientation may play a role in reflux management. Supported sitting positions increase reflux more than other positions. Based on anatomy, the esophagus enters the stomach on the back (posterior) side. Supported sitting places more liquid near the gastro-esophageal junction (where the tube of the esophagus enters the stomach) increasing the incidence of reflux. Poor postural control in infants younger than 6 months contributes to a slumped posture in supported sitting. This posture submerges the gastro-esophageal junction further with stomach contents and increases abdominal pressure contributing to reflux. Overuse of seating positions like swings, bouncers, and car seats exacerbates reflux and limits infant exposure to movements delaying optimal gross motor development.

• #30 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

  Prone with head elevation decreases reflux. 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. […] Left sidelying is better than right sidelying. 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. Soothing your baby with swaddling, a pacifier, or positive touch like infant massage may be effective in decreasing cortisol and improving infant sleep.

• #31

  https://coliccalm.com/pages/acid-reflux-cause-and-treatment-babies?srsltid=AfmBOopbtn1-HxzFZRLQx6eLUTcPbdhKUrnCdhsWjzfkp-0E5MXOHZp0

  Breastfed babies have been shown to have fewer and less severe reflux episodes than their artificially fed counterparts. Human milk is more easily digested than formula and is emptied from the stomach twice as quickly. This is important since any delay in stomach emptying can aggravate reflux. The less time the milk spends in the stomach, the fewer opportunities for it to back up into the esophagus. […] Many parents report promising results with a homeopathic medicine called Colic Calm for controlling reflux and the accompanying discomfort. Many natural health care practitioners are recommending it to parents with babies suffering from GER. By all means, speak with your pediatrician and try this natural homeopathic remedy before resorting to prescription pharmaceuticals. […] If these measures don’t work, the next step is to speak to your doctor about diagnostic evaluation and treatment options. Prescription medicines reduce stomach acid, thereby suppressing the symptoms of esophageal inflammation and pain associated with reflux. Commonly used medications include Zantac for babies (a brand of the H2 blocker ranitidine) or Prevacid for babies (a brand of the proton pump inhibitor lansoprazole). However, since acid-blocking drugs interfere with the body’s natural digestive process, important nutrients such as iron, calcium and folic acid are not absorbed well. […] A natural option is gripe water for reflux such as Colic Calm that does not expose baby to such side effects is usually preferable to drugs or surgery.

• #32 Patient education: Acid reflux (gastroesophageal reflux) in babies (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/acid-reflux-gastroesophageal-reflux-in-babies-beyond-the-basics/print

  If you are breastfeeding, it’s best to continue doing so; don’t switch to formula for the sole purpose of thickening the feeds. […] If your baby has concerning symptoms that might be related to acid reflux, such as severe irritability, feeding refusal, or poor weight gain, talk to their health care provider. […] Medications are not recommended for most babies with reflux, because: Babies with uncomplicated GER („happy spitters”) do not benefit from medicines that reduce stomach acid. […] If your baby has concerning symptoms that might be related to acid reflux, such as severe irritability, feeding refusal, or poor weight gain, talk to their health care provider. […] For most babies with reflux, symptoms go away by one year of age and do not recur later in life. […] You should contact a health care provider immediately if your baby has any of these symptoms: Forceful vomiting after each feed with continued hunger, Vomiting blood, Recurrent pneumonia, Severe diarrhea or bloody stools, Crying for longer than two hours, Refusing to eat or drink anything for a prolonged time (for example, for more than six hours during the daytime).

• #33 Childhood Gastro-oesophageal Reflux: Causes and Treatment

  https://patient.info/childrens-health/childhood-gastro-oesophageal-reflux-leaflet

  Thickening feeds can sometimes help. There are different products available which work to thicken your baby’s feeds. Examples of these include Nestargel and Carobel which thicken milk. You should talk with your doctor before using these products. You may have to make the hole of the teat larger if you use these products. […] Anti-regurgitant formula milks are available – for example, Enfamil AR and SMA Staydown. These can be prescribed by your doctor if your baby has more severe gastro-oesophageal reflux. These should not be given for more than six months and should not be given with any other feed thickener or antacids. […] Gaviscon (sodium alginate) works by making the contents of the stomach thicker so they are then more likely to stay in the stomach. It also forms a protective coating over the lower part of the gullet (oesophagus). In doing so, any stomach contents that rise up into the gullet are less likely to irritate the gullet and cause symptoms.

• #34 Pediatric Reflux Disease > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/pediatric-reflux-disease

  It can take a few days to weeks for the medicine to take effect, Dr. Porto says, adding that he will keep a child on the medication for at least two to four weeks and, if there is an improvement, continue it for three months. […] Once inflammation has gone down, doctors may then have children step down the drugs. […] Occasionally, an upper endoscopy may be needed if symptoms do not improve or if they recur after a child stops the medication. […] In the case of children who need long-term therapy, doctors may perform a pH impedance study. […] Occasionally, a surgical procedure called fundoplication can be performed; this repositions the stomach vis-à-vis the esophagus in order to strengthen the valve between them. […] This procedure is done in special circumstances and with the goal of reducing reflux symptoms and decreasing the need for long-term medications, says Dr. Porto.

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

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

  Non-pharmacological therapies, such as a 2- to 4-week trial of thickened feeds or cows milk protein avoidance, are preferred strategies for symptom improvement. 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. Anticipatory guidance, especially reassuring parents and caregivers about the natural resolution of reflux symptoms in otherwise healthy babies, often negates the need for therapy.

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