Literature review for - Flourish Paediatrics

Treatment
Although GOR is sometimes distressing for parents, and approximately 20% will seek
medical advice, it is important to emphasise the generally benign nature and course of this
symptom, with its tendency to spontaneously resolve by twelve months of age. Therapeutic
intervention is usually reserved for those infants who have complications of their GOR: poor
weight gain and growth, respiratory disease or oesophagitis. Specialised assessment and
investigation may be required to clarify the presence and extent of complications.
For complicated GOR, treatment typically employs a series of treatments, ranging from
modification of feeding patterns, to surgery (Vandenplas, Rudolph et al. 2009).
Change in feeding pattern
For infants the initial treatments are likely to be modification of volume or duration of feeds,
and changes in posture, although there is minimal evidence to support changing feed volume
(Ewer, Durbin et al. 1996). There is no evidence to suggest that cessation of breastfeeding is
beneficial for gastroesophageal reflux, although feeding more frequently, to ensure smaller
volume of milk may be beneficial.
Feed thickening
Thickening of feeds has some benefit in decreasing the amount regurgitated, but has no
efficacy in decreasing number of episodes of GOR or acid exposure, and thus has no real
place in the management of complicated GOR (Horvath, Dziechciarz et al. 2008). In addition
feed thickeners cannot be utilised in breastfeeding. Some have been shown to have adverse
side effects, including delaying gastric emptying and increasing GOR.
Posture
GOR is decreased in infants in the flat prone position compared with the supine position, and
in the head elevated position in comparison with the flat position (Corvaglia, Rotatori et al.
2007; Martin, Di Fiore et al. 2007; van Wijk, Benninga et al. 2007; Omari 2008; Vandenplas,
Rudolph et al. 2009). Recently the supine position at an elevation of 40 degrees was shown in
an open trial to be beneficial (Vandenplas, De Schepper et al. 2010). The prone position is
however associated with increased risks of SIDS and should not be used for sleeping infants
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