Gastric Reflux (GORD)

Gastric reflux (Gastro oesophageal reflux disease – GORD) is common.
Symptoms and treatment are determined by age of the child, and the severity of the symptoms. 

It is also called “heart burn” or “indigestion”.

Reflux disease occurs when the stomach contents (acid and enzymes, as well as food, and sometimes bile) regurgitate back into the oesophagus (gullet).
This hurts. This can cause damage if left untreated.

Symptoms in babies

  • Spilling/ vomiting:  can be at anytime or straight after a feed.
  • Poor feeding: slow reluctant feeding/ short feeds 
  • Distress, crying and inconsolable, irritable, whingy
  • Difficult to settle for sleep/ or cannot stay asleep
  • Gulp with swallowing
  • Grimace and cry with spills/ burps
  • Back arching, poor sleeping, frequent painful waking
  • Weight gain: can be poor for difficult feeds, but over-feeders can get chubby
  • Prefer being in upright position

Symptoms in children

  • Tummy pain, “sore tummy”
  • Heart burn, Regurgitation
  • Slow eating, Won’t eat lumps
  • Irritable  
  • Poor sleep
  • Teeth problems, Sore throat
Reflux can be caused by food intolerance

In reflux babies, about 40%  have been shown to be allergic/intolerant to cow’s milk (see footnote).
If breastfed, mum should try off dairy.
If formula fed – a cow’s milk free formula should be tried.

In older children and adults, a gluten intolerance is a common trigger.

Children and adults who have troublesome gastro-oesophageal reflux symptoms are frequently gluten-sensitive.

These children have high IgG-gliadin antibody levels.
When these children go onto a gluten-free diet, they settle down, they sleep well for the first time, and they begin to eat normally.
They also can often be taken off their medications within a few weeks or months.
Their parents are relieved that at last their distressing problems have been solved.

Valuable webpage

This site will give you more  excellent information.  This group  is “committed to provide support and information to families caring for infants and children with gastric reflux throughout NZ.”   www.cryingoverspiltmilk.co.nz  

Medications

The ChristchurchHospital Department of Paediatrics says in their Health Pathways  “In most instances, reassurance, education, and lifestyle changes are all this is required as symptoms improve over time.”  However, some of these children need acid supression medications to control symptoms. They go onto to state “Use of omeprazole and ranitidine is not indicated in primary care as there is a lack of evidence for their effectiveness and concerns about their safety.”

Your local doctor/GP can still prescribe these medications if they have appropriate experience, or under the recommendation of a specialist. 

We agree that the use of these anti-reflux medications need close supervision.
We are expert in managing the severe reflux child.

Recommendation

If you, your baby or children have these reflux symptoms, the Childrens Clinic (Christchurch) can help you diagnose and manage this distressing illness.
We can arrange investigations, prescribe appropriate medications and work out the best diet. 

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Note: About 40% of infants with GORD have a cow’s milk protein allergy.  Allergy testing may not be useful as this is often a delayed gut reaction (non IgE mediated).  For this reason, if the baby is breastfed, a dairy free diet for mum for up to two weeks is recommended.

Reference: Iacono G, Carroccio A, Cavataio F, Montalto G, Kazmierska I, Lorello D, Soresi M, Notarbartolo A. Gastroesophageal Reflux And Cow’s Milk Allergy In Infants: A Prospective Study. J Allergy Clin Immunol 1996;97:822-7.

 

By Rodney Ford