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:
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).
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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