Presenting symptoms in infants
Reflux symptoms can have an adverse impact on the infant’s quality of life.(4)
Additionally, managing infants with reflux symptoms can also be a source of anxiety(5) for parents/carers and can negatively impact their daily activities, physical health and social life.(6)
It is important to reassure parents/carers that reflux is very common in infants (>40%) and usually does not require further investigation or treatment.(1,2)
Symptoms of Reflux
The most frequently reported symptom is regurgitation after feeds, which can occur daily and up to six times a day.(2,3)
In some infants, regurgitation may be accompanied with signs of ‘marked distress’ and/or complications that require further medical attention. These include:(1,2)
- Distressed behaviour (e.g. excessive crying, irritability, crying while feeding and back arching)
- Chronic cough
- Faltering growth
- Hoarseness
- A single episode of pneumonia
- Unexplained feeding difficulties (e.g. refusing feed, gagging and choking)
Infants up to one year of age who experience any of these symptoms with regurgitation may be diagnosed with gastro-oesophageal reflux disease (GORD).(1,2)
Differentiating between gastro-oesophageal reflux (GOR) and GORD can be difficult as there is no distinguishing diagnostic test. Therefore, each case should be evaluated independently, taking into consideration the typical behaviour of the infant.(1)
The most frequently reported symptom is regurgitation after feeds, which can occur daily and up to six times a day.
Colic and cow’s milk protein allergy: overlapping symptoms
GOR/GORD can also be difficult to distinguish from other aetiologies such as colic(7) and cow’s milk protein allergy (CMPA).(8,9) This is owing to overlapping non-specific symptoms, such as:(7-9)
- Excessive crying
- Irritability
- Back arching
- Distress
- Regurgitation
- Vomiting
It is important to distinctly diagnose reflux from similar conditions to ensure infants are provided with effective symptomatic relief.
Guidelines recommend the following for colic and CMPA:
- NICE CKS. GORD in children. 2019. Available: https://cks.nice.org.uk/gord-in-children#!topicSummary [accessed August 2019]
- NICE guidelines. Gastro-oesophageal reflux disease in children and young people: diagnosis and management. 2015. Available: www.nice.org.uk/guidance/ng1 [accessed August 2019]
- Baird DC, Harker J, Karmes AD. Diagnosis and Treatment of Gastroesophageal Reflux in Infants and Children. Am Fam Physician 2015;92(8):705–14
- Czinn SJ, Blanchard S. Gastroesophageal reflux disease in neonates and infants: when and how to treat. Paediatr Drugs 2013;15(1):19–27
- Cohen RC, O’Loughlin EV, Davidson GP, et al. Cisapride in the control of symptoms in infants with gastroesophageal reflux: A randomized, double-blind, placebo-controlled trial. J Pediatr 1999;134(3):287–92
- Kim J, Keininger DL, Becker S, et al. Simultaneous development of the Pediatric GERD Caregiver Impact Questionnaire (PGCIQ) in American English and American Spanish. Health Qual Life Outcomes 2005;3:5
- NICE CKS. Colic-Infantile. 2017. Available: https://cks.nice.org.uk/colic-infantile#!topicSummary [accessed August 2019]
- Rosen R, Vandenplas Y, Singendonk K, et al. Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). J Pediatr Gastroenterol Nutr 2018;66(3):516–54
- NICE CKS. Cow’s milk protein allergy in children. 2015. Available: https://cks.nice.org.uk/cows-milk-allergy-in-children#!scenario [accessed September 2019]