Gastroesophageal reflux in infants and children - When to reassure and when to go further

OBJECTIVE To review current understanding and approach to diseases resultin g from gastroesophageal reflux (GER) in infants and children. QUALITY OF EVIDENCE Very few randomized or blinded controlled trials have b een reported in this area. MEDLINE searches for gastroesophageal reflux, ga stroesophageal reflux disease, esophagitis, and pulmonary aspiration, using age-limited (all childhood) data, find most articles. Very thorough review s undertaken by both European and North American societies for pediatric ga stroenterology provide up-to-date consensus statements. MAIN MESSAGE Gastroesophageal reflux is a normal phenomenon recognized in i nfants as "spitting up." Understanding the mechanism of transient lower eso phageal relaxation episodes allows physicians to counsel concerned parents that reflux: and spitting up occur universally, but are less visible in chi ldren older than 6 to 12 months. In infants and children, GER can result in a variety of diseases and can cause esophageal and tracheopulmonary damage . Investigation of these diseases can be specific and accurate. Therapy is available, but no drug will stop reflux. Some children suffer intractable G ER with secondary complications (GERD) despite medical treatment. Failure o f therapy could mean patients require surgical intervention. CONCLUSION Visible GER is very common in infants and children and can usual ly be managed with explanation, reassurance, and simple measures. Diseases caused by GER can be investigated specifically and managed with accurately defined therapy.