Regurgitation and Gastroesophageal Reflux 207
3
most effective mechanism of acid blockade, and
while not yet approved below 1 year of age, they
are broadly prescribed in this age group. Re-
sponse to treatment and the need to maintain
prolonged treatment should be regularly reas-
sessed as there appear to be consequences of pro-
longed treatment with PPI. If needed, prolonged
medical treatment is now generally preferred to
surgical interventions for GERD, due to nonneg-
ligible complications and failure rates of the sur-
gical procedures and the relatively benign nature
and high effectiveness of drug treatment ( fig. 2 ).
Vomiting/regurgitation and
poor weight gain
Are there warning
signals?
History and physical examination
Manage
accordingly
Ye s
No
Adequate caloric
intake?
No
Ye s
Abnormal?
Workup for failure to
thrive – see text
Consider upper gastrointestinal series
Dietary management
Protein hydrolysate/amino acid formula
Thickened feeds
Increased caloric density
Ye s
No
Education
Close follow-up
Evaluate further
Improved?
Consultation with pediatric gastrointestinal doctor
Consider acid suppression therapy
Consider hospitalization; observe parent/child interaction
Consider nasogastric or nasojejunal tube feedings
No
Ye s Close follow-upEducation
Fig. 2. The infant with regurgitation
and poor weight gain. Reproduced
and adapted with permission from
Vandenplas et al. [1].
Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 203–208
DOI: 10.1159/000360341