Makindo Medical Notes

Related Subjects: |Encopresis in Children |Enuresis/Bedwetting in Children |Acute Glomerulonephritis in Children |Nephrotic Syndrome in Children |Acute Appendicitis in Children |Gastro-oesophageal reflux in Children |Intussusception in Children |Panayiotopoulos Syndrome in Children |Reflex anoxic attacks in Children

Introduction

• GORD (Gastro-oesophageal reflux disease) 🤢🔥 and oesophagitis in children can cause a wide variety of symptoms, often related to feeding.
• Common symptoms include regurgitation 🍼, distress after feeds 😭, apnoea 😮‍💨, recurrent pneumonia 🫁, failure to thrive 📉, and iron-deficiency anaemia 🩸.

Diagnosis

• Clinical Diagnosis 👩‍⚕️: Usually made from history and symptoms; investigations are not always required.
• Endoscopy 🔬: Consider if eosinophilic oesophagitis is suspected.
• Oesophageal pH Probe 📉: Rarely performed, but can help quantify acid reflux.
• Ultrasound 🖼️: Generally not useful in diagnosing reflux in infants.

Treatment

• Reassurance 🤗: Most cases resolve spontaneously; parents should be reassured, especially in mild cases.
• Avoid Over-feeding 🚫🍼: Reducing feed volume may reduce reflux episodes.
• Medications 💊: Considered in moderate to severe cases:
  • Antacids 🧴: e.g., sodium/magnesium alginate (Infant Gaviscon®) – mixed with water after breastfeeding or with bottle feeds.
  • Feed Thickeners 🥣: Carobel® may be used to reduce regurgitation.
  • Prokinetics & Acid Suppression 🌀: Domperidone (motility) sometimes alongside omeprazole (PPI) to reduce acid.
• Surgery ⚕️: In severe cases with complications (e.g., oesophagitis, failure to thrive, apnoea, bleeding), fundoplication may be considered if not resolved by 6–9 months.

Prognosis

• Most infants outgrow GORD by 6–9 months 🎉 as the gastro-oesophageal junction matures.
• Persistent symptoms beyond infancy require further work-up 🔎 and possible intervention.

Conclusion

• GORD in children is usually self-limiting ✅ and can be managed with reassurance, feeding modifications, and occasional medications.
• Severe or persistent cases may need escalation to pharmacological therapy or surgery, but the outlook is excellent in most children 🌟.