# Gastro-Oesophageal Reflux Disease in Infants - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - 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 date: 2026-08 ## Verified against - NASPGHAN/ESPGHAN Pediatric Gastroesophageal Reflux Clinical Practice Guidelines 2018 ## Treatment metadata - Alginate + Feed Thickener — oral.liquid - Omeprazole — 10 mg — oral.solid ## Complete treatment card ```text GASTRO-OESOPHAGEAL REFLUX DISEASE IN INFANTS 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. Review status: REVIEWED against the source listed above (2026-08) 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 Source NICE guideline "Gastro-oesophageal reflux disease in children and young people: diagnosis and management" (NBK552673) Status traced to the source above 1. ALGINATE + FEED THICKENER [1st line] Adult Not applicable - pediatric entry x 2-4 weeks trial Peds Breastfed infants: mix 1 sachet in 5 mL cooled boiled water and give after feeding. Formula-fed: add 1 sachet per 115 mL formula Source NASPGHAN/ESPGHAN Pediatric Gastroesophageal Reflux Clinical Practice Guidelines 2018 Why First-line conservative management for symptomatic infant reflux after position and volume adjustments Caution 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. Egypt no Egyptian brand matched - prescribe by generic name 2. OMEPRAZOLE [2nd line] Adult Not applicable - pediatric entry x 4-8 weeks trial Peds 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) 3kg -> 3 mg/day 4kg -> 4 mg/day 5kg -> 5 mg/day 6kg -> 6 mg/day 7kg -> 7 mg/day 8kg -> 8 mg/day 9kg -> 9 mg/day 10kg -> 10 mg/day 11kg -> 11 mg/day 12kg -> 12 mg/day 13kg -> 13 mg/day 14kg -> 14 mg/day 15kg -> 15 mg/day 16kg -> 16 mg/day 17kg -> 17 mg/day 18kg -> 18 mg/day 19kg -> 19 mg/day 20kg -> 20 mg/day 21kg -> 20 mg/day (capped) 22kg -> 20 mg/day (capped) 23kg -> 20 mg/day (capped) 24kg -> 20 mg/day (capped) 25kg -> 20 mg/day (capped) 26kg -> 20 mg/day (capped) 27kg -> 20 mg/day (capped) 28kg -> 20 mg/day (capped) 29kg -> 20 mg/day (capped) 30kg -> 20 mg/day (capped) 31kg -> 20 mg/day (capped) 32kg -> 20 mg/day (capped) 33kg -> 20 mg/day (capped) 34kg -> 20 mg/day (capped) 35kg -> 20 mg/day (capped) 36kg -> 20 mg/day (capped) 37kg -> 20 mg/day (capped) 38kg -> 20 mg/day (capped) 39kg -> 20 mg/day (capped) 40kg -> 20 mg/day (capped) 41kg -> 20 mg/day (capped) 42kg -> 20 mg/day (capped) 43kg -> 20 mg/day (capped) 44kg -> 20 mg/day (capped) 45kg -> 20 mg/day (capped) 46kg -> 20 mg/day (capped) 47kg -> 20 mg/day (capped) 48kg -> 20 mg/day (capped) 49kg -> 20 mg/day (capped) 50kg -> 20 mg/day (capped) 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. Caution 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. Egypt OMEPAK 10 MG 14 CAPS. SEDICO 14.40 EGP (1.03/unit) RISEK 10 MG 14 CAPS. JULPHAR 19.20 EGP (1.37/unit) RISEK 10 MG 7 CAPS. JULPHAR 13.20 EGP (1.89/unit) HEALSEC 10 MG 14 CAPS. BORG 32.00 EGP (2.29/unit) FASTCURE 10 MG 21 CAPS. OCTOBER PHARMA 60.00 EGP (2.86/unit) OMEZ 10MG 14 CAPS. PHAROPHARMA 40.00 EGP (2.86/unit) Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)