Rationale:
Regurgitation and vomiting occur in up to 50% of infants under one year of age. A detailed medical history and clinical examination are generally sufficient to differentiate between physiological reflux from gastroesophageal reflux disease (GERD). In infants under one year, 24-hour pH monitoring is not reliable for distinguishing normal reflux from disease and should be reserved for exceptional cases. Acid-suppressing or pro-motility medications have no proven benefit in managing physiological reflux in infants. The use of proton pump inhibitors (PPIs) can have adverse effects, including an increased risk of respiratory infections.
References:
- Lightdale J.R, Gremse D.A and AAP section on gastroenterology, hepatology and nutrition: Gastroesophageal reflux: Management Guidance for the Pediatrician. Pediatrics 2013; 131; e1684.
- Cochrane Database of Systematic Reviews. Pharmacological treatment of children with gastro-oesophageal reflux. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008550.pub2/full
- Orenstein S: Multicenter, double-blind, randomized, placebo-controlled trial assessing the efficacy and safety of proton pump inhibitor lansoprazole in infants with symptoms of gastroesophageal reflux disease. J Pediatr 2009;154: 514-20.