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GORD in Children

 

This guideline applies to children from birth.

 

Introduction

  • Overfeeding is a common cause of GOR/GORD. 
  • Gastro-oesophageal reflux (GOR) is suspected with a presentation of effortless regurgitation of stomach contents.
  • Gastro-oesophageal reflux disease (GORD) is suspected in the event of regurgitation AND one or more of the following: 
  • Distressed behaviour (eg excessive crying, crying while feeding, irritability, and/or back arching or posturing).
  • Hoarseness and/or chronic cough.
  • A single episode of pneumonia.
  • Unexplained feeding difficulties, such as refusing to feed, gagging, or choking.
  • Faltering growth
  • Associated torticollis with neck extension and rotation may indicate Sandifer Syndrome.
  • Children over one year of age may present with heartburn, retrosternal pain, and epigastric pain.

 

In scope   

  • GOR & GORD

 

Not in scope   

  

Red Flag Features

  • Frequent, forceful (projectile) vomiting can indicate Pyloric Stenosis (infants up to 2 months old)
  • Bile-stained vomit suggests intestinal obstruction eg Hirschsprung disease intestinal atresia, volvulus or intussusception
  • Haematemesis (not related to a nosebleed, cracked maternal nipple or melaena) suggests an upper gastrointestinal bleed.  This is an uncommon sign of GOR(D) but is a red flag for button battery ingestion.

 

Investigations required prior to referral

There is no simple, reliable and accurate diagnostic test to confirm GOR or GORD.

 

Management optimisation

  • Review feeding history eg if bottle fed: type of formula, size, timing, frequency of feeds and volume consumed over 24 hrs.  If breastfed- timing, duration, any feeding problems.
  • Review neurodevelopmental history, weight and growth (assess for faltering growth)
  • Feeding assessment see Breastfeeding Advice & Support

 

GOR- suspect if the infant is well, thriving and presents with effortless regurgitation of feeds.

  • Reassurance- resolves in 90% infants before one year of age. 
  • Does not require investigation or treatment.

GORD- if the infant or child is well and thriving and hospital admission is not required:

 

Breastfed infants:

  1. If symptoms persist despite breastfeeding advice consider: 1-2 week trial of alginate therapy eg Gaviscon infant
  2. If symptoms improve after 1-2 weeks: continue with treatment.  Advise parents/carers to stop treatment at 2 week intervals to see if symptoms have improved.
  3. If symptoms persist: consider a 4 week trial of PPI eg Omeprazole.

 

Formula fed infants:

First assess for overfeeding:

  1. Review the feeding history and calculate typical 24 hour intake: (oz x 30 =ml) divided by weight = ml/kg/day.  Total feed volume should be 150ml/kg of body weight over 24 hrs.
  2. Trial of smaller, more frequent feeds (ensuring total volume over 24 hours remains the same) for 1-2 weeks

 

Further Management:

  1. Trial of thickening agents eg thickened formula purchased (do not prescribe) Gaviscon or Carobel OR please see 355_KCCG_Specialist Infant Formula Prescribing 2018.pdf
  2. If unsuccessful: stop pre-thickened formula and offer 1-2 weeks of Gaviscon added to usual formula.  Do not use together due to risk of choking. 
  3. If symptoms improve after 1-2 weeks: continue with treatment.  Advise parents/carers to stop treatment at 2 week intervals to see if symptoms have improved.  Parents/carers to stop treatment at 2 week intervals to see if symptoms have improved.
  4. If symptoms persist: consider a 4 week trial of PPI eg Omeprazole.

 

Advice and Guidance

Send advice & guidance request via eRS to Paediatrics.

 

Referral

Emergency and red flags: 

  • Projectile vomiting or suspected pyloric stenosis
  • Haematemesis
  • Melaena
  • Bile stain vomit

 

Discuss same day admission to hospital by contacting on-call Paediatrician via switchboard RCHT- (01872 250000/01872 225282) or Derriford (01752 202082)

 

Routine referral criteria:

  • Symptoms suggestive of gastro-oesophageal reflux disease (GORD) needing ongoing medical therapy or not responding to medical therapy in primary care.
  • An uncertain diagnosis
  • Persistent, faltering growth associated with regurgitation
  • Unexplained distress in children with communication difficulties.
  • Feeding aversion and a history of regurgitation.
  • Unexplained iron deficiency anaemia.
  • Regurgitation and/or vomiting onset after six months of age or persistent frequent 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.

 

Above conditions are seen as routine.  Please document clinical reasons clearly if referring urgently.

 

Supporting Information

For professionals

 

For patients, parents/carers

 

References

 

Page Review Information

Review date

27 February 2026

Next review date

27 February 2028

Clinical editor

Dr Melanie Schick

Contributors

Dr Matthew Thorpe, Consultant Paediatrician, RCHT