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Gastro-oesophageal reflux disease (GORD) in infants and Children Part 2

Posted by Eamonn Brady on

Eamonn Brady is a pharmacist and the owner of Whelehans Pharmacy, Pearse St, Mullingar. If you have any health questions e-mail them to info@whelehans.ie

This is a continuation of last week’s article.

Treatment

Avoid overfeeding and try increasing frequency and decreasing volume of feeds. The infant should be supported in an upright position whilst feeding and for at least 45 minutes after feeding to bring up wind. The infant should be handled very gently after feeding and during winding; avoid vigorous patting or rocking.

GORD tends to be worse when lying flat and therefore a gentle raise of the head of an infant’s cot can help, so that the infants head is higher than the rest of their body while they sleep. This can be done by putting a pillow or folded blanket under the mattress to create a gentle up slope. Never attempt to let your infant sleep directly on a pillow which could be dangerous.

                  

Products to add to an infant's food

By thickening infant's food, an infant is less likely to bring it back up. Products to thicken an infant’s milk include Instant Carobel® and ready-thickened feeds such as Enfamil AR® or SMA Staydown®. Enfamil AR powder is used as an infant milk and as this product is a pre-thickened infant milk you may need to switch to a faster flow teat to help the infant suck it. If breastfeeding and the infant is having problems with bringing up food, Gaviscon® Infant sachets may be used instead.

 

Infants are less likely to bring up food if they have sodium alginate (Gaviscon® Infant) mixed with their feed or dissolved in water after their meal. Sodium alginate works in three ways; it thickens the milk making it easier for the infant to cope with, coats the oesophagus all the way down to the stomach and in the stomach it forms a raft over the stomach contents, helping to stop the contents of the stomach from escaping back up the oesophagus. Dosage depends on the weight of the infant. Gaviscon® Infant sachet(s) can be mixed with cool boiled water, milk feed or expressed breast milk. Gaviscon® Infant sachet(s) should not be administered more than six times in 24 hours. Gaviscon® Infant should not be given to premature infants, young children who are ill with a high temperature, diarrhoea, vomiting, or if already using a food thickener.  

 

Medication

Anti-reflux medicines reduce the severity of the reflux by improving the downward movement (i.e. motility) of the oesophagus and stomach. They may also reduce acidity so that the reflux is less damaging to the oesophageal lining. They are generally only used if other treatment options like thickeners do not work.

 

Motilium® (Domperidone) helps tighten the valve between stomach and oesophagus stopping food from flowing back into the oesophagus. It comes in liquid or rectal (suppository form) form for infants and children but is only available with a doctor’s prescription. Dose depends on size of child so check with your GP or pharmacist. Motilium® can rarely cause mild diarrhoea.

 

H2 blockers reduce acid in the stomach. Ranitidine which is a type of H2 antagonist and Zantac® is a popular brand of the drug. It is only available on prescription; ask your GP or pharmacist about dosage.

 

Losec® MUPS (omeprazole) is a popular brand of proton pump inhibitor. Losec® MUPS  can be dissolved in water which is convenient for children’s dosage. A proton pump inhibitor reduces the acidity of the stomach’s contents and is more potent than H2 antagonists like Zantac®. The dose for infants and young children is based on body weight and the doctor will decide the correct dose.

Surgery

Surgery is required in a minority of infants with severe GORD who do not respond to treatment but surgery is not always successful. Sometimes medication needs to be continued after surgery.

 This article is shortened to fit within Newspaper space limits. More detailed information and leaflets is available in Whelehans


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