Practice 10-Minute Consultation

Ongoing vomiting in an infant

BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j1802 (Published 04 May 2017) Cite this as: BMJ 2017;357:j1802
  1. Neil Chanchlani, specialist trainee in paediatrics1,
  2. Fiona Davis, general practitioner partner2,
  3. Kalyaan Devarajan, consultant paediatrician3
  1. 1Royal Free London NHS Foundation Trust, London, UK
  2. 2East Hill Surgery, Colchester, Essex, UK
  3. 3Colchester General Hospital, Colchester, Essex, UK
  1. Correspondence to N Chanchlani nchanchlani{at}doctors.org.uk
  • Accepted 29 March 2017

What you need to know

  • Distinguish physiological gastro-oesophageal reflux (GOR) from gastro-oesophageal reflux disease (GORD) based on history and examination

  • GOR is very common and most infants do not require investigations or treatment; aim to educate and reassure parents

  • If a therapeutic trial of pharmacological treatment is necessary, this needs to be structured and followed up within two weeks, with a referral to secondary care if no response

A four week old infant is brought to see you by her mother who is concerned that her baby vomits after feeds several times a day. The baby is otherwise well, formula fed, and is thriving with no other symptoms.

Involuntary passage of a baby’s stomach contents back up the oesophagus is a common, normal physiological event. The infant might or might not regurgitate or vomit shortly after feeding, several times a day.1 This is known as gastro-oesophageal reflux (GOR), and can be associated with feed refusal, crying, and back arching.2 As the lower oesophageal sphincter has not yet matured, milk refluxes through the opening into the oesophagus, causing discomfort for the infant (fig 1). GOR resolves without investigation or treatment.

Fig 1 Mechanism of gastro-oesophageal reflux

Consider gastro-oesophageal reflux disease (GORD) if symptoms of regurgitation interfere with the baby’s quality of life or cause complications, such as poor weight gain, difficulty in sleeping, and recurrent chest infections1.1

It can be difficult to distinguish between colic—excessive, frequent crying in a well baby—and GOR, GORD, or “fussy eating” because of the overlap of symptoms and the lack of useful investigations. In one Australian cohort study, GOR was reported by parents in almost a quarter of infants. Symptoms commenced in the first month of life in 50% of cases and resolved by six months for 75% of infants.2 In comparison, prevalence …

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