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Clinical Question
What approach should we take to treat gastroesophageal symptoms in children?
Bottom line
Citing overinvestigation and overtreatment of infants and children with symptoms of reflux, this guideline recommends, in the absence of alarm signs, dietary changes but no proton pump inhibitor (PPI) therapy for infants. In older children, lifestyle and dietary changes should come first, saving short-term acid-suppression therapy (4-8 weeks) only for when these changes don't work, and then referral to a pediatric gastroenterologist for further work-up only if symptoms persist or return after discontinuing acid suppression. 5
Reference
Study design: Practice guideline
Funding: Self-funded or unfunded
Setting: Various (guideline)
Synopsis
These guidelines were developed by the North American and the European societies for pediatric gastroenterology, hepatology, and nutrition. The guideline development group consisted solely of specialists without patient or other specialty representation. The group included a methodologist. Most of the group members had financial conflicts of interests. The guideline was based on a systematic review of the literature and the quality of the evidence was graded. The group differentiated gastroesophageal reflux as a set of symptoms, defining gastroesophageal reflux disease as reflux accompanied by troublesome "red flag" findings, such as esophagitis. The guidelines suggest a conservative approach, basing initial treatment on reported symptoms without an extensive work-up. Initial treatment of infants should include thickened feed for treating regurgitation/vomiting (weak recommendation), avoiding overfeeding (weak recommendation), and attempting a trial of hydrolyzed protein formula if these approaches don't work (weak recommendation). Head elevation while sleeping can be tried in children but not infants (weak recommendation). PPI therapy should not be used in healthy infants or infants with regurgitation, but can be used in children with typical heartburn symptoms (strong recommendation).
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
Comments
I DON'T DO INFANT OR GI PROBLEMS BUT I DON'T SEE ANYTHING NEW,CONSERVATIVE RX LIKE CHANGING LIFESTYLE
INCREASE ACTIVITY EXERCISES ALWAYS HAVE TO BE TRIED BEFORE ANY INTERVENTION THEY ARE EFFECTIVE IN 60-80% OF SPINAL PROBLEM , BUT I WOULD LIKE TO ADD LIFESTYLE CHANGES SHOULD BE FOR LIFE.
C’est bon qu’on peut moins medicamenter ces enfants et bébés.
Useless. It does not address whether or not the infant is gaining weight!
sssso: do nothing, really, beyond common sensical things, tarted up with medical jargon, until things get better. If getting worse, refer to a specialist. Not much here for an F.P.
well, they would wouldn't they? (recommend referral to themselves)
We know that Fodmap is a real thing in adults with some GI issues. Why not consider same with infants?
Excellent
Good poem
I have tried lifestyle modifications such as raising the head of the bed, last meal early in the evening, regular physical activity ( which is usually provided at schools). If the symptoms don't improve, i usually refer to pediatric GI for further investigations and start of the drug treatment if indicated.