GORD

• Why does gastro-oesophageal reflux occur in children?


  Immature lower oesophageal sphincter -> allows stomach contents to easily enter oesophagus
• Most babies have some reflux, which is normal under 1 yr.

  If reflux is associated with pain or complications -> GORD
• What are the RFs for reflux in babies?


  Short oesophagus & weak oesophageal sphincter

  Oesophageal sphincter is located above the diaphragm

  Gastric distension due to liquid diet & high energy needs

  Babies spend significant proportions of their lives lying flat -> easier for food contents to move back into the oesophagus
• What are the RFs for GORD in children?


  Preterm birth

  Parental GORD

  Obesity

  Structural abnormalities (hiatus hernia, repaired oesophageal atresia, diaphragmatic hernia)

  Cerebral palsy
• What are the signs & symptoms of GORD in infants?


  Chronic cough

  Hoarse cry

  Distress, crying or unsettled after feeding

  Reluctance to feed

  Pneumonia

  Poor weight gain

  Vomiting

  Over 1 -> heartburn, acid regurgitation, epigastric/chest pain, bloating & nocturnal cough
• What are the red flags to look out for in terms of reflux?


  Not keeping down food (? pyloric stenosis/intestinal obstruction)

  Projectile vomiting (? pyloric stenosis/intestinal obstruction)

  Haematemesis or melaena (? peptic ulcer, varices, CMPA)

  Abdominal distension (? intestinal obstruction)

  Reduced consciousness, bulging fontanelle, neurological signs (? meningitis or raised ICP)

  Signs of infection

  Rash, angioedema, other signs of allergy

  Resp symptoms (inc apnoea)
• What are the DDx of GORD in children?


  Congenital hiatus hernia

  Gastroenteritis

  Pyloric stenosis
• What are the Inx for GORD in children?


  Obs

  Focused Hx & examination

  Bloods (FBC, U&Es, LFTs, CRP)

  Abdominal USS

  Gastroscopy (to see if any signs of oesophagitis)

  Upper GI contrast study (exclude hiatus hernia or achalasia)

  pH impedance study (an NG tube with a probe to monitor pH is inserted & records pH over 24 hours)
• What is the management of GORD in children?


  Reassurance & practical advice (1st line)

  • small, frequent meals
  • burping regularly to help milk settle
  • not over-feeding
  • keep baby upright after feeding

  Gaviscon mixed with feeds

  Thickened milk or formula

  PPIs
• What are the possible complications of GORD in children?


  Reflux oesophagitis

  Recurrent infections (aspiration pneumonia, acute otitis media)

  Dental complications

  Apnoeic episodes
• When does GOR becomes GORD?

  When pt becomes symptomatic → faltering growth, pain (arching back, becoming unsettled) → signs of oesophagitis