Reflux Info
Treatments for GOR & GORD
Non medical therapies
Non medication therapies for gastro-oesophageal reflux (GOR), have been proven to be very effective in many cases.
If you are sure there are no signs warning signs that you should be looking out for and the spitting up feeds is becoming distressing to you or your infant, then the following suggestions may help. Please note they can take 2-3 weeks before any improvement is seen.
| Avoid over-feeding |
Ask your medical professional about appropriate sized bottles or
nursing routines |
| Avoid exposure to smoke (tobacco/other): this causes irritability |
| Burp (wind) your baby frequently before, during and after feeding |
| Keep your baby upright after feeds for at least 30 minutes |
| Avoid the use of car seats immediately after feeding |
| Avoid clothing or nappies that are tight around the abdomen |
| Where possible try not to lay your infant flat |
| A 30-degree angle above horizontal is recommended |
| Raise the mattress or head of the cot |
| Place a cushion under your infant’s head when changing nappies |
Your doctor may also advise a trial of a hypoallergenic formula if bottle feeding, or if breast feeding a removal of dairy or soy milk proteins from the mothers diet to evaluate if it is food allergy related.
Medications
Thickening milk
Sometimes a doctor may recommend that formula milk be thickened to help the baby to keep it down. A commercial thickener may be prescribed or your doctor may simply suggest using baby rice or oatmeal.
Infant Gaviscon
Often the first medication prescribed for reflux in babies and children. Infant Gaviscon thickens the milk making it easier for the baby to cope with.
Histamine-2-receptor antagonists (H2-blockers)
H2-blockers are drugs that block or prevent the production of gastric (stomach) acid. A pump in the stomach releases hydrochloric acid when stimulated by histamine. H2 blocks prevent histamine from stimulating this pump, thereby reducing to amount of acid released into the stomach.
H2-blockers don´t completely neutralise the gastric acid. They are effective for about 50% patients.
Here are a list of some of the more common H2-blockers
- famotidine (Pepcid)
- nizatidine (Axid)
- ranitidine (Zantac).
Side affects can be dizziness, headache, gynecomastia, malaise
Proton pump inhibitors (PPI):
PPI´s are the most effective way of reducing acid secretion, as they stop acid secretions at the source of acid production. They work by shutting down a system with in the stomach known as proton pumps.
They are usually most effective when given in a single dose before the first meal of the day. Timing of the dose it critical to the success of PPI's and incorrect administration can often be a reason why the treatment fails. Although there are circumstances were an additional dose may be required in the evening.
Some of the more common PPI`s are:
Side affects can include headaches, diarrhea, abdominal pain, asthenia (weakness), flatulence (wind), dry mouth
Prokinetic agents (motility drugs):
These medications speed up the emptying of the stomach. Some of them also help to close the sphincter muscle at the opening of the stomach.
Some common Prokinetic agents include
- Domperidone,
(is one of the most common and should be given 1/2hr to 20 minutes before food)
Vitamin and mineral supplement
If the patient isn't getting enough vitamins and minerals in their diet, they may be advised to take supplements as poor nutrition can lead to further complications.
Dosage of these medications is weight dependent. If the medication is no longer proving effective, you should check with a member of the medical profession.
Often medications that are prescribed for reflux are not registered for children under the age of 12 years old. This is quite normal and is a question we are frequently asked about.
Note: for further information on medications commonly used with infants please visit Drug therapy of gastro-oesophageal reflux in children.
In extremely rare cases of GORD a surgical approach may be considered, the most common at present is the Nissans fundoplication
Click here for the References
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