Gastroesophageal reflux in infants and children. When to reassure and when to go further.

OBJECTIVE To review current understanding and approach to diseases resulting from gastroesophageal reflux (GER) in infants and children.

QUALITY OF EVIDENCE Very few randomized or blinded controlled trials have been reported in this area. MEDLINE searches for gastroesophageal reflux, gastroesophageal reflux disease, esophagitis, and pulmonary aspiration, using age-limited (all childhood) data, find most articles. Very thorough reviews undertaken by both European and North American societies for pediatric gastroenterology provide up-to-date consensus statements.

MAIN MESSAGE Gastroesophageal reflux is a normal phenomenon recognized in infants as "spitting up." Understanding the mechanism of transient lower esophageal relaxation episodes allows physicians to counsel concerned parents that reflux and spitting up occur universally, but are less visible in children older than 6 to 12 months. In infants and children, GER can result in a variety of diseases and can cause esophageal and tracheopulmonary damage. Investigation of these diseases can be specific and accurate. Therapy is available, but no drug will stop reflux. Some children suffer intractable GER with secondary complications (GERD) despite medical treatment. Failure of therapy could mean patients require surgical intervention.

CONCLUSION Visible GER is very common in infants and children and can usually be managed with explanation, reassurance, and simple measures. Diseases caused by GER can be investigated specifically and managed with accurately defined therapy.