Metoclopramide, thickened feedings, and positioning for gastro-oesophageal reflux in children under two years

Double‐Blind Comparative Trial With 2 Antiregurgitation Formulae

“…In that trial, half of the patients were treated with regular formula, which was shown to reduce the frequency of regurgitation by approximately 25%, confirming the efficacy of reassurance (17); however, the ARF decreased regurgitation by approximately 50% (17). A Cochrane review from 2004 concluded that thickened feeds reduce the regurgitation severity score (standardized mean difference À0.94; 95% confidence interval [CI] À1.35 to À0.52) as well as the frequency of emesis (standardized mean difference À0.91; 95% CI À1.22 to À0.61) (18). Horvath et al (19) stated that thickened feeding was only moderately effective in GER in healthy infants, although they also concluded that thickened formula significantly increased the number of infants without regurgitation, slightly reduced the number of episodes of regurgitation and vomiting, and increased weight gain.…”

Double‐Blind Comparative Trial With 2 Antiregurgitation Formulae

“…In that trial, half of the patients were treated with regular formula, which was shown to reduce the frequency of regurgitation by approximately 25%, confirming the efficacy of reassurance (17); however, the ARF decreased regurgitation by approximately 50% (17). A Cochrane review from 2004 concluded that thickened feeds reduce the regurgitation severity score (standardized mean difference À0.94; 95% confidence interval [CI] À1.35 to À0.52) as well as the frequency of emesis (standardized mean difference À0.91; 95% CI À1.22 to À0.61) (18). Horvath et al (19) stated that thickened feeding was only moderately effective in GER in healthy infants, although they also concluded that thickened formula significantly increased the number of infants without regurgitation, slightly reduced the number of episodes of regurgitation and vomiting, and increased weight gain.…”

Pediatric Laryngopharyngeal Reflux in the Last Decade: What Is New and Where to Next?

“…In infants and children, behavioral modifications for LPRD typically center on the following actions: Altering food composition. Thickening of milk and feedings with starch, cereals, carob bean thickeners, or xantham gum improves laryngeal sensation and overall swallowing function and may help in reducing regurgitations and the signs and symptoms of reflux disease as suggested by two systematic reviews of the relevant literature [ 103 , 104 ]. Breastfeeding.…”

“… Keeping an infant in a relatively vertical position for at least 30 min after feeding. Elevating the head of the bed may be used in preschool and school-aged children but is not recommended in infants and children younger than two years of age, as it is uncertain that it helps reduce reflux, but, most importantly, because of the risk of suffocating, as it may cause the baby to slide down to the foot of the cot or under the beddings [ 3 , 104 , 109 , 110 ]. Sleep positioning may provide further benefits to infants; however, the ideal position remains a subject of debate [ 66 , 111 ].…”

“…Elevating the head of the bed may be used in preschool and school-aged children but is not recommended in infants and children younger than two years of age, as it is uncertain that it helps reduce reflux, but, most importantly, because of the risk of suffocating, as it may cause the baby to slide down to the foot of the cot or under the beddings [ 3 , 104 , 109 , 110 ].…”

Are there risks associated with empiric acid suppression treatment of infants and children suspected of having gastroesophageal reflux disease?

“…44 Furthermore, conservative therapy, such as decreased volume and thickened feeds, has been found to decrease GERD symptoms in infants. 45 With the exception of endoscopically confi rmed erosive esophagitis, acid-suppressive medications have not been shown to have a benefi cial role in GERD, particularly in infants <1 year of age. 10 The majority of cases improve when left to their natural course.…”

Double‐Blind Comparative Trial With 2 Antiregurgitation Formulae

“…In that trial, half of the patients were treated with regular formula, which was shown to reduce the frequency of regurgitation by approximately 25%, confirming the efficacy of reassurance (17); however, the ARF decreased regurgitation by approximately 50% (17). A Cochrane review from 2004 concluded that thickened feeds reduce the regurgitation severity score (standardized mean difference À0.94; 95% confidence interval [CI] À1.35 to À0.52) as well as the frequency of emesis (standardized mean difference À0.91; 95% CI À1.22 to À0.61) (18). Horvath et al (19) stated that thickened feeding was only moderately effective in GER in healthy infants, although they also concluded that thickened formula significantly increased the number of infants without regurgitation, slightly reduced the number of episodes of regurgitation and vomiting, and increased weight gain.…”

Pediatric Laryngopharyngeal Reflux in the Last Decade: What Is New and Where to Next?

“…In infants and children, behavioral modifications for LPRD typically center on the following actions: Altering food composition. Thickening of milk and feedings with starch, cereals, carob bean thickeners, or xantham gum improves laryngeal sensation and overall swallowing function and may help in reducing regurgitations and the signs and symptoms of reflux disease as suggested by two systematic reviews of the relevant literature [ 103 , 104 ]. Breastfeeding.…”

“… Keeping an infant in a relatively vertical position for at least 30 min after feeding. Elevating the head of the bed may be used in preschool and school-aged children but is not recommended in infants and children younger than two years of age, as it is uncertain that it helps reduce reflux, but, most importantly, because of the risk of suffocating, as it may cause the baby to slide down to the foot of the cot or under the beddings [ 3 , 104 , 109 , 110 ]. Sleep positioning may provide further benefits to infants; however, the ideal position remains a subject of debate [ 66 , 111 ].…”

“…Elevating the head of the bed may be used in preschool and school-aged children but is not recommended in infants and children younger than two years of age, as it is uncertain that it helps reduce reflux, but, most importantly, because of the risk of suffocating, as it may cause the baby to slide down to the foot of the cot or under the beddings [ 3 , 104 , 109 , 110 ].…”

Are there risks associated with empiric acid suppression treatment of infants and children suspected of having gastroesophageal reflux disease?

“…44 Furthermore, conservative therapy, such as decreased volume and thickened feeds, has been found to decrease GERD symptoms in infants. 45 With the exception of endoscopically confi rmed erosive esophagitis, acid-suppressive medications have not been shown to have a benefi cial role in GERD, particularly in infants <1 year of age. 10 The majority of cases improve when left to their natural course.…”

Double‐Blind Comparative Trial With 2 Antiregurgitation Formulae

“…In that trial, half of the patients were treated with regular formula, which was shown to reduce the frequency of regurgitation by approximately 25%, confirming the efficacy of reassurance (17); however, the ARF decreased regurgitation by approximately 50% (17). A Cochrane review from 2004 concluded that thickened feeds reduce the regurgitation severity score (standardized mean difference À0.94; 95% confidence interval [CI] À1.35 to À0.52) as well as the frequency of emesis (standardized mean difference À0.91; 95% CI À1.22 to À0.61) (18). Horvath et al (19) stated that thickened feeding was only moderately effective in GER in healthy infants, although they also concluded that thickened formula significantly increased the number of infants without regurgitation, slightly reduced the number of episodes of regurgitation and vomiting, and increased weight gain.…”

Pediatric Laryngopharyngeal Reflux in the Last Decade: What Is New and Where to Next?

“…In infants and children, behavioral modifications for LPRD typically center on the following actions: Altering food composition. Thickening of milk and feedings with starch, cereals, carob bean thickeners, or xantham gum improves laryngeal sensation and overall swallowing function and may help in reducing regurgitations and the signs and symptoms of reflux disease as suggested by two systematic reviews of the relevant literature [ 103 , 104 ]. Breastfeeding.…”

“… Keeping an infant in a relatively vertical position for at least 30 min after feeding. Elevating the head of the bed may be used in preschool and school-aged children but is not recommended in infants and children younger than two years of age, as it is uncertain that it helps reduce reflux, but, most importantly, because of the risk of suffocating, as it may cause the baby to slide down to the foot of the cot or under the beddings [ 3 , 104 , 109 , 110 ]. Sleep positioning may provide further benefits to infants; however, the ideal position remains a subject of debate [ 66 , 111 ].…”

“…Elevating the head of the bed may be used in preschool and school-aged children but is not recommended in infants and children younger than two years of age, as it is uncertain that it helps reduce reflux, but, most importantly, because of the risk of suffocating, as it may cause the baby to slide down to the foot of the cot or under the beddings [ 3 , 104 , 109 , 110 ].…”

Are there risks associated with empiric acid suppression treatment of infants and children suspected of having gastroesophageal reflux disease?

“…44 Furthermore, conservative therapy, such as decreased volume and thickened feeds, has been found to decrease GERD symptoms in infants. 45 With the exception of endoscopically confi rmed erosive esophagitis, acid-suppressive medications have not been shown to have a benefi cial role in GERD, particularly in infants <1 year of age. 10 The majority of cases improve when left to their natural course.…”