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GORD in Children

 

Suspect GORD in any infant (up to 1 year of age) or child if they present with regurgitation and one or more of the following:

 

  • Distressed behaviour (shown, for example, by excessive crying, crying while feeding, and adopting unusual neck postures)
  • Hoarseness and/or chronic cough.
  • A single episode of pneumonia.
  • Unexplained feeding difficulties (for example refusing to feed, gagging, or choking).
  • Faltering growth.

Note: additional features such as episodic torticollis with neck extension and rotation may indicate the presence of Sandifer's syndrome.

Children over 1 year of age may present with heartburn, retrosternal pain, and epigastric pain.

 

RED FLAGS

Admit if:

  • Projectile vomiting and concerns of pyloric stenosis
  • Haematemesis
  • Melena

 

Otherwise refer if:

  • An uncertain diagnosis or red flag symptoms which suggest a more serious condition.
  • Persistent, faltering growth associated with regurgitation
  • Unexplained distress in children with communication difficulties.
  • Symptoms suggestive of gastro-oesophageal reflux disease (GORD) needing ongoing medical therapy or not responding to medical therapy.
  • Feeding aversion and a history of regurgitation.
  • Unexplained iron deficiency anaemia.
  • No improvement in regurgitation after 1 year of age.
  • Suspected Sandifer's syndrome (characterised by episodic torticollis with neck extension and rotation).
  • Suspected complications such as - recurrent aspiration pneumonia, unexplained apnoeas, unexplained epileptic seizure-like events, unexplained upper airway inflammation, dental erosion associated with a neurodisability, recurrent acute otitis media already managed appropriately.

     



 

Additional notes:

* The use of thickened formulas and alginate therapy together is not recommended.

** Omeprazole suspension is a special order. Ranitidine suspension is available, please see the BNF for dose [off label use].

 

Please see the KCCG guideline ‘Appropriate Prescribing of Specialist Infant Formula’ for more information on prescribing 

 

References:

Clinical Knowledge Summaries, NICE https://cks.nice.org.uk/gord-in-children, Last revised September 2020.

 

Contributors:

Dr Matthew Thorpe, Consultant Paediatrician, RCHT

Mike Wilcock, Prescribing Unit, Royal Cornwall Hospital, January 2018.

 

Date Reviewed                                 July 2021

Date Next Review                             July 2022

GP RMS Author                                Dr S Burns

 

Version No. 1.2