The National Institute for Health and Care Excellence (NICE) has recently published new guidelines providing healthcare professionals with evidence-based advice on the recognition, diagnosis and management of gastro-oesophageal reflux disease in children and young people.
Introduction
Reflux in infants and young children can be very distressing for parents and carers who are often frustrated by the uncertainty of the condition and lack of medical interventions available to resolve the problem. However, it is worth noting that it is typically self-limiting and can be managed through primary care.
The new guidelines help support medical professionals to make the correct diagnosis and help them reduce concerns in parents and carers of children with reflux issues. It also means infants, children and young people with severe reflux get the care that they need while also avoiding over-treating otherwise healthy children.
Differential diagnosis for improved management
Gastro-oesophageal reflux (GOR) can be quite normal but it is often difficult to differentiate from more serious underlying causes of reflux. As a result, assessing whether a condition is serious enough to warrant treatment or a referral can be a difficult and stressful process.
To help this, the new guidelines highlight a number of “red flag” symptoms that may suggest disorders other than GOR, all of which warrant further investigation. These include:
- Projectile vomiting
- Bile-stained vomit
- Haematemesis
- Abdominal distension or tenderness
- Chronic diarrhoea
Nutrition first management options
The NICE guidance offers practical suggestions for the management of reflux in both breastfed and formula fed infants with frequent regurgitation. The guidance initially focuses on a nutrition-first approach, starting with feeding assessments and adjustment of feed volumes and frequency.
If feeding adjustments do not prove to be successful, NICE recommends a trial of thickened formulas in formula-fed infants, such as Cow & Gate anti-reflux to help alleviate the condition.
As a first step intervention, thickened1 formulas can eliminate or reduce the frequency of reflux issues and in turn help minimise the stress that reflux causes parents. If the initial approach is not effective, NICE suggest a trial of alginate for a short period, before resorting to more invasive, diagnostic procedures.
More information about the NICE guidance is available at http://www.nice.org.uk/guidance/NG1.
