December Week 2: Gastroesophageal Reflux


  1. Michail S, et al. Gastroesophageal Reflux. Peds in Review. 2007;28;101-110
  2. (you don’t have to read ALL 50 pages – the tables are the most useful part)Vandenplas Y, et al. Pediatric Gastroesophageal Reflux Clinical Practice Guidelines. Journal of Pediatric Gastroenterology and Nutrition, Vol. 49, No. 4, October 2009.

Case 1:

A 4 month old female is brought in by mom for well visit. Mom complains that she spits up with every feed and is constantly changing her clothes because they are always wet with vomit. She gives her 8 oz of formula every 4 hours. Her height and weight are both 80th percentile. She reports a friend told her she should switch to a special formula and wants to know what she should do. 
What questions do you ask mom? 
What are some underlying causes of reflux in infants? 
What do you advise her? Should she change the feeds? 
Which kids do you have to worry about not outgrowing their GER?

If the child had not been gaining weight, or if she had any “red flag” signs, how would you proceed? Explain which diagnostic tests are useful and when to order them. 
What are some complications of GERD in infants?

Case 2:

Parents bring their 3 week old son to your office because they found flecks of blood in his diaper this morning. He has been feeding well, breastfeeding exclusively, every 2-3 hours. Birth weight was 3.35 kg, today’s weight is 3.28 kg. Parents do not note any vomiting, discomfort during feeds, abdominal distention, lethargy. He has been otherwise acting normally, no excessive crying, normal activity and wet diapers.

What do you think is going on? 
What do you advise the parents?