Gastro-oesophageal Reflux (1)

Question 1

Why does this occur in babies?

When is it normal to occur?
→ When does it become concerning?

Answer 1

➊ Their LOS is much weaker than in an adult, therefore it’s much easier for gastric contents to reflux into the oesophagus

➋ After a large feed in first 6 months of life as the LOS develops
→ When there’s an effect on growth or the baby becomes distressed

Question 2

How does it present?

Answer 2

• Milky vomit after feeds
• Arching of back during feeding
• Distress, crying or irritability after feeding
• Reluctance to feed
• Poor weight gain

Question 3

What are the red flag symptoms here? What does each indicate?

Answer 3

• Projectile vomiting – Pyloric stenosis
• Bile-stained vomit + distension – Bowel obstruction
• Haematemesis/Melaena – Gastroenteritis, dysentery, intussusception
• Respiratory symptoms – Aspiration → Infection
• Signs of allergy – Cow’s milk protein allergy

Question 4

How do most cases progress?

How is it managed?

What is its rare complication?
→ What occurs here?

Answer 4

➊ Resolve as baby grows and LOS develops

➋ • Conservative
‣ Small, frequent meals – Don’t overfeed
‣ Keep baby upright post-feeds
‣ Burp after feeds
• Medical – Gaviscon (Antacid), PPI

➌ Sandifer’s Syndrome
→ Brief episodes of Torticollis (neck contraction to twist neck) and dystonic posturing associated with GORD – Tends to resolve once reflux resolves