What causes gastro-oesophageal (GOR) in children?

GOR occurs when the lower oesophageal sphincter inappropriately relaxes and opens thereby allowing passage of ingested food and gastric acid into the oesophagus. Infants have immature musculoskeletal function and spend most of their time in the supine or slumped sitting positions which facilitates the development of GOR. In children, a family history of GOR is not a risk factor for symptoms of GOR.

What are the symptoms and history of reflux?

GOR is symptomatic in 4% of individuals. The constellation of dyspepsia, irritability, poor sleep and vomiting is termed GOR. The majority of children with GOR will experience lifelong symptoms.

How is reflux diagnosed?

For a differential diagnosis of GOR, it is important to consider eosinophilic oesophagitis in children with a personal or family history of atopy. An empiric trial of anti-reflux treatment is not typically helpful when making a diagnosis of GOR. Barium swallow is the gold standard for GOR.

What is the pharmacist’s role in the management of GOR?

Pharmacists can advise parents regarding over-the-counter solutions such as thickening agents and antacids. Pharmacists knowledge on the administration of medications to babies and children is crucial to successful management. Various proprietary preparations of feed thickeners and antacids are available for addition to expressed breast or formula milk.

Is there a link between reflux and allergy or respiratory disease?

The link between GOR and respiratory symptoms is clearly defined. If GOR is observed in children with cow’s milk protein intolerance (CMPI) then a change in feeding regime is recommended. Pharmac has guidance regarding the Special Authority criteria for use of specialised formulas for CMPI.