Dawaa Reference

Clinical reference

Gastro-Oesophageal Reflux Disease in Infants

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources3 sources

Gastro-oesophageal reflux disease in children and young people: diagnosis and management (NICE Guideline NG1, 2019) - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK552673/ · NASPGHAN/ESPGHAN Pediatric Gastroesophageal Reflux Clinical Practice Guidelines 2018 · Rosen R, Vandenplas Y, Singendonk M, Cabana M, DiLorenzo C, Gottrand F, Gupta S, Langendam M, Staiano A, Thapar N, Tipnis N, Tabbers M. Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of NASPGHAN and ESPGHAN. J Pediatr Gastroenterol Nutr. 2018 Mar;66(3):516-554. doi:10.1097/MPG.0000000000001889. PMCID: PMC5958910.

Verified against1 document
  • NASPGHAN/ESPGHAN Pediatric Gastroesophageal Reflux Clinical Practice Guidelines 2018

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Red flags (5)

  • Tell parents to return if regurgitation becomes persistently projectile, if there is bile-stained (green or yellow-green) vomiting or blood in the vomit, if there is new marked distress, feeding difficulty or faltering growth, or if it persists beyond the first year
  • Same-day specialist assessment for an infant under 2 months with progressively worsening or forceful vomiting of feeds - possible hypertrophic pyloric stenosis
  • Refer for possible upper GI endoscopy with biopsies for haematemesis not caused by swallowed blood, melaena, or dysphagia - same day if clinically indicated
  • Also refer for no improvement in regurgitation after 1 year old, persistent faltering growth with overt regurgitation, feeding aversion with a history of regurgitation, unexplained iron-deficiency anaemia, or suspected Sandifer syndrome
  • Refer persistent back arching, or Sandifer syndrome - episodic torticollis with neck extension and rotation

Symptoms — what the patient reports (4)

  • Effortless regurgitation of feeds in a well infant is very common - at least 40% of infants - and usually begins before 8 weeks of age [regurgitation]
  • 5% of affected infants have 6 or more episodes a day, and it resolves in 90% before the first birthday
  • In children and young people the symptoms of reflux are heartburn, retrosternal pain and epigastric pain [abdominal pain · chest pain · epigastric pain · heartburn]
  • Marked distress alongside frequent regurgitation is what separates the formula-fed infant needing stepped care from one needing only reassurance [regurgitation]

Tests (5)

  • Do not offer an upper gastrointestinal contrast study to diagnose GORD or to assess its severity
  • Perform an urgent same-day upper GI contrast study for an infant with unexplained bile-stained vomiting, to rule out mid-gut volvulus
  • Offer an upper GI contrast study for a child or young person with a history of GORD presenting with dysphagia
  • Consider an oesophageal pH study, with impedance if available, for suspected recurrent aspiration pneumonia, unexplained apnoea, unexplained non-epileptic seizure-like events, unexplained upper airway inflammation, frequent otitis media, or suspected Sandifer syndrome
  • Investigate for urinary tract infection in an infant with regurgitation if there is faltering growth or onset after 8 weeks of age

If not this — what else fits (5)

  • Do not routinely investigate or treat for reflux if a child without overt regurgitation has only one of: unexplained feeding difficulties such as refusing to feed, gagging or choking; distressed behaviour; faltering growth; chronic cough; hoarseness; or a single episode of pneumonia
  • Non-IgE-mediated cows' milk protein allergy can look like GORD, especially with atopic symptoms, signs or a family history
  • More common with premature birth, a parental history of heartburn, obesity, hiatus hernia, repaired congenital diaphragmatic hernia or oesophageal atresia, and neurodisability
  • Reflux is more common in children with asthma but has not been shown to cause or worsen it
  • Complications to recognise: reflux oesophagitis, recurrent aspiration pneumonia, frequent otitis media (more than 3 episodes in 6 months), and dental erosion in a child with neurodisability

SourceNICE guideline "Gastro-oesophageal reflux disease in children and young people: diagnosis and management" (NBK552673)

Presentation findings are traced to the source above.

1

ALGINATE + FEED THICKENER

1st line

Formoral.liquid

Adult dose and duration

Not applicable - pediatric entry x 2-4 weeks trial

Paediatric dose

Breastfed infants: mix 1 sachet in 5 mL cooled boiled water and give after feeding. Formula-fed: add 1 sachet per 115 mL formula

Dose source

NASPGHAN/ESPGHAN Pediatric Gastroesophageal Reflux Clinical Practice Guidelines 2018

Why

First-line conservative management for symptomatic infant reflux after position and volume adjustments

Cautions
  • Uncomplicated 'happy spitters' require reassurance and positioning, NOT acid suppression.
  • Do not use alginates in preterm infants or those with diarrhoea/fever (risk of hypernatremia).
  • Ensure formula is not over-concentrated when using thickeners.
Egyptian brands

No Egyptian brand matched — prescribe by generic name.

2

OMEPRAZOLE

2nd line

Strength10 mg

Formoral.solid

Adult dose and duration

Not applicable - pediatric entry x 4-8 weeks trial

Paediatric dose

1 mg/kg/day [child max 20 mg]

(1 mg/kg once daily in the morning (max 20 mg) for 4-8 weeks in documented GORD with oesophagitis or severe pain/failure to thrive)

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50kg20 mg/day (capped)
Dose source

NASPGHAN/ESPGHAN Pediatric Gastroesophageal Reflux Clinical Practice Guidelines 2018

Why

Proton pump inhibitor reserved for infants with confirmed, complicated gastro-oesophageal reflux disease (e.g. poor weight gain, oesophagitis) rather than simple regurgitation, given the guideline's caution about infection and microbiome risks with unnecessary acid suppression in this age group.

Cautions
  • Acid suppressants are NOT indicated for uncomplicated regurgitation.
  • There is an increased risk of gastroenteritis, CAP, and altered gut microbiome in infants on long-term PPIs.
  • Re-evaluate after 4-8 weeks and taper off.
Egyptian brands
Egyptian brandManufacturerIndicative price
OMEPAK 10 MG 14 CAPS.SEDICO14.40 EGP (1.03/unit)
RISEK 10 MG 14 CAPS.JULPHAR19.20 EGP (1.37/unit)
RISEK 10 MG 7 CAPS.JULPHAR13.20 EGP (1.89/unit)
HEALSEC 10 MG 14 CAPS.BORG32.00 EGP (2.29/unit)
FASTCURE 10 MG 21 CAPS.OCTOBER PHARMA60.00 EGP (2.86/unit)
OMEZ 10MG 14 CAPS.PHAROPHARMA40.00 EGP (2.86/unit)

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.