Please enable JavaScript.
Coggle requires JavaScript to display documents.
GORD in children (Clinical presentation (Crying, Chronic cough,…
GORD in
children
Clinical
presentation
Crying
Chronic cough
Regurgitation
Hoarseness
Feeding difficulty
(cholking, gagging, refusal)
Poor growth
Complications
Infections
Aspiration pneumonia
Recurrent OM
Dental erosion
Reflux oesophagitis
Apnoea
Differentials
Congenital/genetic
Pyloric stenosis
Sandifer's syndrome
Trauma
Obstruction
Infection
Meningitis
Gastroenteritis
UTI
RTI
Autoimmune/immune
Infant cows milk protein allergy
Epidemiology
Regurgitation very common in infants
GORD is uncommon
Usually starts <8w age
Pathophysiology
Mechanism
Transient lower oesophageal sphincter relaxation,
allowing food to pass from stomoch to oesophagus
Causes malnutrition (faltering growth), oesophagitis,
pulmonary aspiration, dystonic neck posturing (Sandifer syyndrome), apparent life threatening events (SIDS)
Anatomy in infants
Short narrow oesophagus
Delayed gastric emptying
Short lower oesophageal sphincter located
above the diaphragm (rather than below in adults)
Liquid diet and high caloric need (strain on gastric capacity)
High gastric:oesophageal volume
Contributing factors
Overfeeding
Recumbent feeding
Risk factors
Obesity
Congenital disorders
Hiatus hernia
Diaphragmatic hernia (post surgery)
Oesophageal atresia (post surgery)
Neurodisability e.g. CP
FH
Hearburn, regurgitation
Diagnosis
(clinical)
Examination
Abdo exam
Distension, mass (obstruction)
Neuro exam
Bulging fontanelle (meningitis),
lethargy
Resp exam
Cough, hoarseness, crackles (infection)
Investigations
Bedside
Obs (any fever)
Measurements: head (raised ICP head
will rapidly increase in size), weight, length
Imaging
Endoscopy +/- biopsy (R/O other causes)
Contrast studies (functional/structural abnormality)
Bloods
FBC (may have anaemia)
Special tests
24h oesophageal pH testing (degree of reflux,
see large and freq pH drops)
History
PMH
Growth and development
Vaccinations
Known medical conditions
DH
Meds, allergies
POH
Scans, bloods, growth, gestation,
delivery, weight, complications
FH
GIT conditions, recently unwell,
atopy or food intolerances
PC/HPC
Regurgitation, poor feeding, poor growth,
crying, cough, hoarse cry, any apnoea
Type of milk (breast, bottle), preparation of milk,
frequency of feeding, amount, difficulties
Stools (type, frequency, consistency)
Any fever, weight loss
SH
Living arrangements,
social support
Management
Conservative
Information, advice, support
Referral to paeds if red flags/unclear diagnosis
Advice on feeding (reduce formula volume if excessive)
Medical
Antacid
Indication: breast fed baby with freq symptoms and distress;
formula fed baby if thickeners not worked
E.g. alginate (Gaviscon Infant)
MOA: neutralises stomach acid,
reducing pain and discomfort
Feed thickeners
Indication: formula fed, freq regugitation, distress
E.g. Enfamil, SMA staydown
MOA: thickened feed for easier swallow and
reduced volume consumed
PPI
Indication: refractory to antacid therapy
E.g. omeprazole 4wk trial
MOA: reduces stomach acidity
Surgical
Fundoplication
Indication: severe oesophagitis, fail to thrive, apnoea
MOA: fundus wrapped around oesophagus to
strengthen the lower oesophageal sphincter
Definition
GOR
Involuntary passage of gastric
contents into theoesophagus
GORD
Troublesome reflux e.g
reflux oesophagitis
Prognosis
Resolves before 1y in most infants due to
maturation of GIT and changing diet
Often becomes less frequent with time