Gastro-oesophageal Reflux

This tends to occur in newborns as their lower oesophageal sphincter (LOS) is much weaker than in an adult, therefore making it easier for gastric contents to reflux back up into the oesophagus. It's very common to occur after a large feed in the first 6 months of life as the LOS develops. But, it becomes a concern when there’s an effect on baby's growth or the baby becomes distressed.

Presentation

• Milky vomit after feeds

• Arching of back during feeding

• Distress, crying or irritability after feeding

• Reluctance to feed

• Poor weight gain

Red flag symptoms to look out for are:

• Projectile vomiting → Pyloric stenosis

• Bile-stained vomit + distension → Bowel obstruction

• Haematemesis/Melaena → Gastroenteritis, dysentery, intussusception

• Respiratory symptoms – Aspiration, which can lead to infection

• Signs of allergy → Cow’s milk protein allergy

In most cases, the symptoms resolve as the baby grows and the LOS develops.

Management

• Conservative

  • Small, frequent meals – Don’t overfeed

  • Keep baby upright post-feeds

  • Burp after feeds

• Medical – Gaviscon (Antacid), PPI

Complication

A rare complication that can occur here is Sandifer’s Syndrome, which is where there are brief episodes of Torticollis (neck contraction to twist neck) and dystonic posturing associated with the GORD. This also tends to resolve alongside the reflux symptoms.