Clinical Review

From Drug and Therapeutics Bulletin

Managing gastro-oesophageal reflux in infants

BMJ 2010; 341 doi: 10.1136/bmj.c4420 (Published 27 August 2010)
Cite this as: BMJ 2010;341:c4420

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  1. Drug and Therapeutics Bulletin
  1. 1Drug and Therapeutics Bulletin Editorial Office, BMA House, London WC1H 9JR
  1. dtb{at}bmjgroup.com

    Summary points

    • Gastro-oesophageal reflux is common in infants, particularly preterm babies, younger infants, and those with neurodevelopmental disorders

    • Reflux is usually self limiting and without complications. Occasionally, it is associated with troublesome symptoms or complications (such as respiratory disorders or suspected oesophagitis), when it is known as gastro-oesophageal reflux disease (GORD)

    • Parental education and reassurance, changes in feeds, thickening of fluids, or an alginate combination should be tried first for managing GORD. Infants whose symptoms are unresponsive, or those with complications, should be referred to specialist paediatric services for investigation

    • An H2 receptor antagonist to reduce acid secretion may be needed to control the condition, but there is little evidence to support such therapy. Ranitidine, which is licensed for use from 6 months of age, is now recommended by the BNF for Children as the most suitable such drug for infants

    • If an H2 receptor antagonist is unsuccessful, the next step is treatment with omeprazole (unlicensed in infants) or surgery

    • No other drugs are licensed or recommended for GORD in infants

    Transient, inappropriate relaxation of the lower oesophageal sphincter may permit contents of the stomach to pass into the oesophagus (gastro-oesophageal reflux).1 This usually presents as regurgitation or vomiting and is common in infants, when it is usually mild and self limiting, and requires no specific treatment.1 Gastro-oesophageal reflux disease (GORD) in infants describes reflux of gastric contents that causes troublesome symptoms or complications.2 GORD is sometimes wrongly diagnosed in healthy infants with troublesome but harmless symptoms of “physiological” gastro-oesophageal reflux.3 This has led to increasing, potentially inappropriate, use of acid reducing drugs.3 4 Furthermore, few of the drugs used to treat infants with GORD are licensed for this use, a situation that DTB criticised 12 years ago.1 Here we consider GORD in infancy …

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