Pediatric Nutrition in Practice

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