The National Institute for Health and Care Excellence (NICE) updated their guidelines on Jan 2015, all treatments offered by the NHS are in accordance with these.
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 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 exposure to smoke (tobacco/other) - it causes irritability
- Avoid over-feeding – ask your medical professional about appropriate sized bottles, nipples or nursing routines
- Burp (wind) your baby frequently before, during and after feeding
- Avoid the use of car seats immediately after feeding
- Avoid clothing or nappies that are tight around the abdomen
*** In line with current NHS guidelines on sudden infant death syndrome, infants should be placed on their back to sleep. Under current guidelines, sleeping and positional management of reflux is no longer advised. For further details, check the latest NHS guidance on sudden infant death syndrome.
What your doctor may advise further:
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 symptoms are, connected to a food allergy. Because exclusion of milk from your diet, or of cow or soy milk from your infant’s diet can compromise nutritional status and require supplements, this should be done under the supervision of a doctor or dietician.
Thickening milk – Sometimes a doctor may recommend that formula milk be thickened to help the baby to keep it down. A commercial thickener maybe prescribed or an over the counter specialist milk formulas may be suggested – please note it is important to seek advice from a health care professional first, as there may be dietary implications when adding to or changing infants feeds.
Infant Gaviscon – Often the first medication prescribed for reflux in babies and children. Infant Gaviscon thickens the milk making it easier for the child to cope with. DO NOT give Infant Gaviscon with additional thickening agents or infant formula milk preparations containing a thickening agent. For further advice please see the Infant Gaviscon patient leaflet and consult with your pharmacists or doctor should you have any concerns.
Medications – Gastro-oesophageal Reflux Disease (GORD)
The following medications may be considered by your doctor, if GORD is suspected
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 the amount of acid released into the stomach.
Proton pump inhibitors (PPI’s):
PPI´s are an effective way of reducing acid secretion in the stomach, as they stop acid secretions directly at the source of acid production. They work by shutting down a system within 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. 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.
The most common PPI’s prescribed are omeprazole and lansoprazole, some of which can now be obtained in a syrup form.
Prokinetic agents (motility drugs):
These medications speed up the gastric emptying of the stomach and are very rarely prescribed in the treatment of reflux (GOR) and reflux disease (GORD).
The most common motility medications prescribed in the United Kingdom are metoclopramide, domperidone or erythromycin. The National Institute for Health and Care Excellence (NICE) 2015 recomendations outline motility medications should only be prescribed by specialist paediatric healthcare professionals, after all other treatment options for reflux have failed.
Enteral tube feeding:
In very rare cases where infants and children display failure to thrive or there are respiratory concerns, enteral tube feeding may be suggested by your specialist, to help your child with nutritional needs, read more here.
In extremely rare cases of GORD were all other treatment has failed and life threatening symptoms are present, a surgical approach may be considered, the most common at present is the Nissans Fundoplication.
Click here for the References