Gastro Esophageal Reflux (GER) refers to the physiological mechanism of reflux of gastric contents into the distal esophagus which may happen several times in all individuals through day and night. It is effortless, painless and does not affect growth. When the suffix “D” is attached to GER it means that the process is no longer physiological. It denotes significant distress to the patient or the care giver.
Growth faltering is one of the major reasons when GER should be called GERD i.e. Gastroesophageal Reflux Disease. A child who is growing well on growth charts is unlikely to suffer from GERD.
Positioning : Utilising the gravitational force as help to prevent reflux is a well-known mechanism. Prone and side position also helps as the angulation at the Lower Esophageal sphincter(LES) is less predisposed to reflux in these positions. Prone position is recommendedonlypost infancy.
Thickening of feed is helpful in neonates and infants suffering with GERD, as the rates of reflux are lower in children who are fed thickened feeds.
Proton Pump Inhibitors (PPI’s) continue to be the mainstay of pharmacotherapy in all children with GERD. They have replaced the H2 receptor antagonists as they provide sustained acid suppression.
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