Updated: 12/25/2021

Gastroesophageal Reflux (GER) in Infants

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  • Snapshot
    • An 8-month-old girl is brought to the pediatrician by her parents for a well-baby visit. The parents report that their only concern is that the patient "spits up" her food. The parents say that she is exclusively breastfed and denies any increased irritability, abnormal behavior, diarrhea, or vomiting. Physical examination is unremarkable. Parent education and recommendations are implemented.
  • Introduction
    • Clinical definition
      • gastric contents going into the esophagus in the absence of pathologic consequences
        • a normal physiologic process that occurs in infants, children, and adults
        • note that gastroesophageal reflux disease (GERD) results in pathologic consequences (e.g., esophagitis)
  • Epidemiology
    • Incidence
      • very common in infants and
        • the frequency decreases with increasing age
  • ETIOLOGY
    • Pathogenesis
      • transient lower esophageal sphincter relaxation
  • Presentation
    • Symptoms
      • "spitting" up
        • healthy infants are sometimes called "healthy spitters"
    • Physical exam
      • typically a normal physical exam
  • Differential
    • GERD
      • symptoms
        • failure to thrive
        • feeding difficulties
        • arching of the back
        • irritability
      • complications
        • esophagitis
        • Barrett esophagus
        • strictures
        • adenocarcinoma in severed GERD
  • DIAGNOSIS
    • Diagnostic criteria
      • this is a clinical diagnosis
  • Treatment
    • Conservative
      • increasing caloric density while decreasing feed volume
        • indication
          • may be helpful in patients with GER
      • thickening feeds
        • indication
          • thickening the feeds with agents such as rice cereal will increase the caloric density of the feeds and may decrease reflux in GER
  • Complications
    • By definition GER is considered in the setting of reflux without pathological consequences
  • Prognosis
    • Uncomplicated GER has a favorable prognosis because
      • the infant will "outgrow" the frequency of regurgitation
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