Management of gastro-oesophageal reflux in children 1 year or older
Children with reflux may benefit from the same diet and lifestyle modifications as adults (see Diet and lifestyle modification for the management of gastro-oesophageal reflux). The effect of sleep position has not been studied in children.
If diet and lifestyle modifications are ineffective and reflux symptoms are problematic or associated with complications, a trial of proton pump inhibitor (PPI) therapy may be indicated. In children, symptoms often improve with a trial of a PPI for 4 to 8 weeks. Granules or rapidly dispersible tablets may be more palatable and easier to give to children than standard tablets. Suitable regimens include12:
1esomeprazole 0.7 mg/kg up to 20 mg orally, daily, half to one hour before a meal. Granules can be dispersed in water esomeprazole esomeprazole esomeprazole
OR
1lansoprazole 1 mg/kg up to 30 mg orally, daily, half to one hour before a meal. The orally disintegrating tablet can be placed on the tongue to dissolve lansoprazole lansoprazole lansoprazole
OR
1omeprazole 0.7 mg/kg up to 20 mg orally, daily. The tablets can be dispersed in water, orange juice or yoghurt omeprazole omeprazoleomeprazole
OR
1pantoprazole 1.2 mg/kg up to 40 mg orally, daily, half to one hour before a meal. Granules can be sprinkled onto a spoon of apple sauce or swallowed with a small amount of water or apple or orange juice. pantoprazole pantoprazolepantoprazole
In children who experience breakthrough symptoms, PPIs may be more effective when given in 2 divided doses.
If PPI therapy is ineffective or long-term therapy is required, seek expert advice. Baclofen can be used as an adjunct therapy to PPI therapy in children with refractory GORD under the care of a paediatric gastroenterologistVadlamudi, 2013.
There is insufficient evidence to justify using prokinetic drugs (eg metoclopramide, domperidone, prucalopride) to treat GORD in children, and adverse effects are likely to outweigh their benefitsVadlamudi, 2013. In children with GORD (confirmed by endoscopy or 24-hour impedance studies with or without oesophageal manometry studies) who do not respond to medical therapy or have life-threatening complications of GORD, antireflux surgery may be considered. Careful patient selection is important because fundoplication surgery may be associated with significant adverse effects.