There are no specific distinguishing features that can predict response to dietary modification, nor are any investigations helpful in CMPA.Symptoms usually occur within a few weeks of exposure to cow milk protein.Up to 40% of infants presenting with symptoms of GORD will have non-IgE mediated Cow Milk Protein Allergy (CMPA).One particular brand of standard cow milk formula does not confer benefit over another, nor do they vary in their content of dairy GOR alone is not an indication to change formula or stop breast feeding.
Gord treatment options trial#
Consider a trial of smaller, more frequent feeds in these infants if practical Reducing feed volumes can reduce regurgitation but should only be considered if excessive for infant's weight. Assess feed volumes in formula fed infants to identify overfeeding.Observation and assessment of feeds by an experienced lactation consultant or Maternal Child Health Nurse (MCHN) can be helpful.Ensure the infant is not being given sodium alginate (Gaviscon Infant®) as co-administration increases risk of bowel obstruction.Thickened feeds can contribute to constipation."Anti-reflux" formulas are pre-thickened, or alternatively a thickening agent can be added to a standard formula or expressed breast milk.In bottle fed babies, thickened feeds may reduce frequency of vomiting.Prone sleeping or inclining the sleep surface is not recommended in infants due to the risk of SIDS.Holding the infant in a head elevated position for 20–30 minutes after feeding may reduce GOR.Simple GOR can cause considerable parental distress, and requires reassurance, support and anticipatory guidance. Investigations should only be considered on an individual basis after the patient has been assessed by a paediatrician. Investigations for GORD (such as barium contrast radiography, pH probe, endoscopy) are rarely necessary, and are not diagnostic. Bulging fontanelle and/or increasing head circumference.
Vomiting that is bilious has onset >6 months of age or is consistent and forceful.Of the following red flag features are present: Symptoms Direct observation of a feed by an experienced clinician can be particularly useful to identify exacerbating factors.Both GOR and GORD can be diagnosed on detailed history and examination.Blood and/or mucous in stool, chronic diarrhoea or atopic risk factors make this diagnosis more likely.Milk protein allergy (CMPA) can present with similar symptoms to GORD Gastro-oesophageal reflux disease is when GOR causes vomiting with: There is insufficient evidence to support the diagnosis or management of "silent reflux" can usually be managed with parental education, support and anticipatory guidance.Infant crying peaks at 6-8 weeks, and hence some babies with simple GOR may also be unsettled does not cause crying and irritability in healthy infants.usually begins before 8 weeks of age, peaks at 4 months and resolves by 1 year of age in majority of cases.is common, affecting at least 40% of infants.It is a physiological process that occurs several times a day in healthy infants. Gastro-oesophageal reflux (GOR) is the passage of gastric contents into the oesophagus, often with effortless vomiting, or 'possets'. The natural history of GORD is of resolution with time any therapy commenced should be reviewed regularly.Empiric use of acid suppression for unsettled infants is not effective and may cause harm.GORD is not a common cause of unexplained crying, irritability or distressed behaviour in otherwise healthy infants.Gastro-oesophageal reflux disease (GORD) should be differentiated from physiological gastro-oesophageal reflux, which is common in healthy, thriving babies and does not require specific investigations or management.
Unsettled or crying babies Gastroenteritis Key points