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GORD in Children

When to refer:

Admit if:

  • Projectile vomiting and concerns of pyloric stenosis
  • Haematemesis
  • Melena

Otherwise refer if:

  • An uncertain diagnosis or red flagsymptoms which suggest a more serious condition.
  • Persistent, faltering growth associated with regurgitation.
  • Unexplained distress in children with communication difficulties.
  • Symptoms suggestive of gastro-oesophageal reflux disease (GORD) needing ongoing medical therapy or not responding to medical therapy.
  • Feeding aversion and a history of regurgitation.
  • Unexplained iron deficiency anaemia.
  • No improvement in regurgitation after 1 year of age.
  • Suspected Sandifer's syndrome.
  • Suspected complications such as - recurrent aspiration pneumonia, unexplained apnoeas, unexplained epileptic seizure-like events, unexplained upper airway inflammation, dental erosion associated with a neurodisability, recurrent acute otitis media already managed appropriately.

 

When to suspect:

 
 

Suspect GORD in any infant (up to 1 year of age) or child if they present with regurgitation and one or more of the following:

o          Distressed behaviour (shown, for example, by excessive crying, crying while feeding, and adopting unusual neck postures).

o          Hoarseness and/or chronic cough.

o          A single episode of pneumonia.

o          Unexplained feeding difficulties (for example refusing to feed, gagging, or choking).

o          Faltering growth.

?         Note: additional features such as episodic torticollis with neck extension and rotation may indicate the presence of Sandifer's syndrome.

Children over 1 year of age may present with heartburn, retrosternal pain, and epigastric pain.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Additional notes:

* The use of thickened formulas and alginate therapy together is not recommended.

** Omeprazole suspension is a special order.

Ranitidine suspension is available, please see the BNF for dose.

 

Please see the KCCG guideline ‘Appropriate Prescribing of Specialist Infant Formula’ for more information on prescribing - https://www.eclipsesolutions.org/UploadedFiles/355_KCCG_Specialist%20Infant%20Formula%20Prescribing%202018.pdf

 

References:

Clinical Knowledge Summaries, NICE https://cks.nice.org.uk/gord-in-children, Last revised in March 2015.

Dr Rebecca Harling, GP and RMS Lead for Paediatrics, November 2017

Dr Matthew Thorpe, Consultant Paediatrician, RCHT, November 2017.

Mike Wilcock, Prescribing Unit, Royal Cornwall Hospital, January 2018.

 

 

Date Reviewed                                 14/08/2019

Date Next Review                            14/08/2020

GP Sifter                                            Dr Rebecca Harling

 

 

Version No. 1.1