Literature review for - Flourish Paediatrics

Regurgitation, gastroesophageal reflux and feeding related behaviours
Gastroesophageal reflux is the regurgitation of stomach contents to the oesophagus, mouth, or
externally, and is recognised by regurgitant vomiting or spilling of feeds. It is common in
infancy with more than half of children reported to have GOR at 3-6months of age (Nelson,
Chen et al. 1997; Iacono, Merolla et al. 2005; Furuta, Liacouras et al. 2007; Hegar, Dewanti
et al. 2009). In the majority of infants GOR spontaneously resolves by 12 months of age.
Limited data suggests that breastfeeding is not causative of, nor protective against GOR,
although fully breastfed infants regurgitate less frequently than those who are formula or
partially breastfed (Heacock, Jeffery et al. 1992; Iacono, Merolla et al. 2005; Hegar, Dewanti
et al. 2009).
Assessment of Gastroesophageal reflux
In assessing any infant with GOR it is essential to consider other causes of vomiting
including systemic and enteric infections, intestinal obstructions including pyloric stenosis,
metabolic disease and neurological disorders. Regurgitant vomiting is the most important
symptom of GOR. A range of other symptoms is ascribed to GOR, but it is not always
possible to confirm the relationship between GOR and the particular symptoms. For most
infants there is no association between GOR and disease (Nelson, Chen et al. 1997; Hegar,
Dewanti et al. 2009). A small group of infants will develop complications of GOR growth
failure, oesophagitis or respiratory disease. Clinical history of regurgitant vomiting plus poor
growth or haematemesis (vomiting blood), apnoea or respiratory symptoms, anaemia, or
abnormal posturing warrant a careful medical review and sometimes more detailed
investigation (Vandenplas, Rudolph et al. 2009).
More difficult to assess are infants with irritability and feeding refusal. In an Australian
study Heine et al investigated a cohort of infants aged 0.5 to 8.2 months who presented with
persistent fussiness and found no association between the number of episodes of acid reflux
or the total period of acid exposure of the oesophagus and gastroesophageal reflux (Heine,
Jordan et al. 2006). They found no association between back-arching and acid reflux. They
concluded that in the absence of frequent vomiting GOR is unlikely to account for fussiness
in infancy.
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