Gastroesophageal Reflux in Infants and Children -- American Family Physician

www.aafp.org/afp AMERICAN FAMILY PHYSICIAN 1853 with no underlying systemic abnormalities. GER is a common condition involving regurgitation, or “spitting up,” which is the passive return of gastric contents retrograde into the esophagus. The prevalence of GER peaks between one to four months of age, and usually resolves by six to 12 months of age. No gender predilection or definite peak age of onset beyond infancy has been established. Regurgitation has been reported in 40 to 65 percent of healthy infants, but decreases to 1 percent by one year of age. Gastroesophageal reflux disease (GERD) is a pathologic process in infants manifested by poor weight gain, signs of esophagitis, persistent respiratory symptoms, and changes in neurobehavior (Table 1). Abnormal signs and symptoms that warrant a diagnosis of GERD occur in approximately one in 300 infants. After the first year of life, GERD is more resistant to complete resolution. A higher prevalence of GERD is present in children who have the following: a history of esophageal atresia with repair; neurologic impairment and delay; hiatal hernia; bronchopulmonary dysplasia; asthma; and chronic cough (Table 2). GERD is also associated with pulmonary aspiration, chronic bronchitis, and bronchiectasis. A common symptom complex in infants is gastroesophageal reflux (GER), which causes parental anxiety resulting in numerous visits to the physician. The etiology of GER has not been well defined. In addition to simple parental reassurance and thickened feedings, multiple diagnostic and treatment options are available. The term GER implies a functional or physiologic process in a healthy infant Gastroesophageal reflux is a common, self-limited process in infants that usually resolves by six to 12 months of age. Effective, conservative management involves thickened feedings, positional treatment, and parental reassurance. Gastroesophageal reflux disease (GERD) is a less common, more serious pathologic process that usually warrants medical management and diagnostic evaluation. Differential diagnosis includes upper gastrointestinal tract disorders; cow’s milk allergy; and metabolic, infectious, renal, and central nervous system diseases. Pharmacologic management of GERD includes a prokinetic agent such as metoclopramide or cisapride and a histamine-receptor type 2 antagonist such as cimetidine or ranitidine when esophagitis is suspected. Although recent studies have supported the cautious use of cisapride in childhood GERD, the drug is currently not routinely available in the United States. (Am Fam Physician 2001;64:1853-60. Copyright© 2001 American Academy of Family Physicians.) O A patient information handout on gastroesophageal reflux in infants and children, written by the author of this article, is provided on the AFP Web site. Gastroesophageal Reflux in Infants and Children