Practice Guidelines

Gastro-oesophageal reflux disease in children: NICE guidance

BMJ 2015; 350 doi: (Published 14 January 2015) Cite this as: BMJ 2015;350:g7703
  1. Ieuan Davies, consultant paediatric gastroenterologist1,
  2. Shona Burman-Roy, senior research fellow and guideline lead2,
  3. M Stephen Murphy, clinical director, children’s health2
  4. on behalf of the Guideline Development Group
  1. 1Department of Paediatric Gastroenterology, University Hospital of Wales, Cardiff CF14 4XW, UK
  2. 2National Collaborating Centre for Women’s and Children’s Health, Royal College of Obstetricians and Gynaecologists, London NW1 4RG, UK
  1. Correspondence to: I Davies ieuan.davies{at}

The bottom line

  • Frequent, effortless regurgitation of feeds is common during early infancy. Although worrying for parents, it usually resolves by the age of 1 year and usually does not need investigation or specific treatment. Effective management requires detailed, repeated, and confident reassurance

  • For infants and children who present with regurgitation or vomiting, actively look out for “red flags” (such as projectile vomiting, bile stained vomiting, haematemesis, blood in stool, abdominal distension, or systemic features) that may suggest more serious conditions

  • Consider simple cheap interventions, such as minor feed modifications or thickening agents, when possible and avoid acid suppressing drugs in isolated overt regurgitation

  • Do not use upper gastrointestinal contrast radiology to diagnose or assess the severity of gastro-oesophageal reflux disease. This test is indicated for other reasons such as dysphagia or unexplained bile stained vomiting

Gastro-oesophageal reflux is a normal physiological event, whereas gastro-oesophageal reflux disease (GORD) occurs when this process causes symptoms severe enough to merit medical treatment or when there are associated complications. In infants and children it is particularly difficult to differentiate between the two conditions because of the wide variety of potential symptoms and the lack of a simple, reliable, and widely available diagnostic test. The true burden of the problem is therefore difficult to quantify, and it is accepted that clinical practice varies greatly.

Children affected by the disease include premature and term neonates, otherwise well infants and children, and those with known risk factors, such as repaired diaphragmatic hernia and other congenital anomalies or severe neurodisabilities. This last group of children may have complex comorbidities and the underlying pathophysiology may have important differences.

This article summarises the most recent guidance from the National Institute for Health and Care Excellence (NICE) on how to recognise, diagnose, and manage gastro-oesophageal reflux disease in infants, children, and young people. …

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