A) Daily regurgitation is common in infants, peaking at age 3-4 months
Daily regurgitation is common in infants, peaking at age 3-4 months, and improving significantly by age 12 months. Crying with regurgitation may indicate pain from GER, but may also be behavioral or associated with milk protein allergy. GERD is only diagnosed and treated when there are troubling associated symptoms, such as failure to thrive. The right side sleeping position results in worsened esophageal acid exposure and reduced esophageal clearance. Sandifer syndrome is a rare presentation of GER that must be differentiated from seizures and infantile spasms. It improves with antireflux therapy. Diagnosis of GERD is most often made clinically. For infants, feeding smaller amounts more frequently, keeping in a prone or left side position (only while awake, not for sleeping), and thickening feeds may improve symptoms. Antireflux medications are not recommended for infants. Lifestyle changes for older children include avoiding triggering foods, weight loss if obese, avoidance of late night eating, elevation of the head of the bed, and prone or left-sided sleeping position. Medical therapies include H2 blockers, PPIs, and antacids. Prolonged PPI courses should be avoided.
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June 30, 2021 at 6:38 pm
A) Daily regurgitation is common in infants, peaking at age 3-4 months
Daily regurgitation is common in infants, peaking at age 3-4 months, and improving significantly by age 12 months. Crying with regurgitation may indicate pain from GER, but may also be behavioral or associated with milk protein allergy. GERD is only diagnosed and treated when there are troubling associated symptoms, such as failure to thrive. The right side sleeping position results in worsened esophageal acid exposure and reduced esophageal clearance. Sandifer syndrome is a rare presentation of GER that must be differentiated from seizures and infantile spasms. It improves with antireflux therapy. Diagnosis of GERD is most often made clinically. For infants, feeding smaller amounts more frequently, keeping in a prone or left side position (only while awake, not for sleeping), and thickening feeds may improve symptoms. Antireflux medications are not recommended for infants. Lifestyle changes for older children include avoiding triggering foods, weight loss if obese, avoidance of late night eating, elevation of the head of the bed, and prone or left-sided sleeping position. Medical therapies include H2 blockers, PPIs, and antacids. Prolonged PPI courses should be avoided.