Paediatrics Q9

Gastro-Esophageal Reflux Disease (GERD) in Infants

Presentation

Age Group: Commonly seen in infants under 1 year old. If the symptoms persist beyond the first year, consider the possibility of a hiatus hernia.

Symptoms:

1. Excessive and frequent regurgitation or vomiting after feeding.

2. Feeding difficulties

3. Failure to gain weight or grow properly (Failure to Thrive)

4. Irritability and persistent crying

Diagnosis

For severe symptoms only. When indicated, diagnostic tools may include:

1. Oesophageal 24-hour pH Study

2. Upper GI Study with Contrast

3. Upper GI Endoscopy with Biopsy: Performed to evaluate the condition of the oesophagus and stomach lining.

Treatment

i. Breastfeeding Assessment: If the infant is breast-fed, a breastfeeding assessment is crucial.

ii. Formula Feeding: For formula-fed infants, a detailed feeding history should be taken. Consider increasing the frequency of feeds while reducing the amount fed each time. You can also switch to a thickened formula.

iii. Medications: If the symptoms persist with no improvement, consider using proton pump inhibitors (PPIs) or H2 receptor antagonists (H2RAs).

iv. Enteral Feeding: If the treatments do not help, consider enteral feeding as a last resort.

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