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Updated: May 7, 2026
Simultaneous Laryngopharyngeal and Conventional Esophageal pH Monitoring
Published on: December 14, 2020
Management of paediatric GERD
1Department of Pediatrics, UZ Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium.
Insights
Managing pediatric gastroesophageal reflux disease (GERD) is complex due to varied symptoms. Proton pump inhibitors (PPIs) are overused in infants, despite potential adverse events and limited evidence of acid-related conditions.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Disorders
- Clinical Management
Background:
- Pediatric gastroesophageal reflux disease (GERD) presents diverse and challenging symptoms, particularly in infants where frequent regurgitation with distress prompts medical consultation.
- GERD diagnosis in children (2-10 years) often relies on extra-esophageal symptoms lacking strong evidence, with diagnostic tools showing limited validation.
- GERD symptoms overlap with cow's milk protein allergy and eosinophilic esophagitis, complicating accurate diagnosis and management.
Purpose of the Study:
- To review the complexities in diagnosing and managing pediatric GERD.
- To highlight the challenges in differentiating GERD from other infant conditions like cow's milk allergy.
- To discuss current treatment strategies, including medication overuse and surgical interventions.
Main Methods:
- Literature review of pediatric GERD management strategies.
- Analysis of diagnostic challenges and symptom overlap with other conditions.
- Evaluation of current therapeutic approaches, including pharmacological and surgical options.
Main Results:
- Infant reflux management focuses on reassurance, diet, and positioning; proton pump inhibitors (PPIs) are frequently overused despite potential adverse effects like gastroenteritis and respiratory infections.
- GERD in older children (2-10 years) is often linked to extra-esophageal symptoms without robust evidence, and diagnostic methods lack validation.
- Prokinetic agents show limited benefit for non-erosive reflux disease due to adverse effects, while surgery is reserved for severe, life-threatening cases or drug dependency.
Conclusions:
- Current management of pediatric GERD requires careful consideration of diagnostic limitations and the risks associated with overused medications like PPIs.
- Alternative diagnoses and non-pharmacological interventions should be prioritized for infant reflux.
- Evidence-based guidelines are needed to optimize GERD treatment in children, reserving advanced interventions for specific indications.
Abstract:
Paediatric GERD is complicated to manage, as symptoms are diverse and often difficult to interpret. In infants, regurgitation is a common physiological condition. Nevertheless, when it occurs frequently (>4 times per day) and causes the infant distress, parents often seek medical help. In children 2-10 years of age, GERD is often considered to cause extra-oesophageal symptoms, despite the absence of hard evidence. Diagnostic investigations often lack solid validation and the signs and symptoms of GERD overlap with those of cow's milk protein allergy and eosinophillic oesophagitis. Reassurance, dietary treatment and positional adaptations are recommended for troublesome infant reflux. Anti-acid medication, mainly PPIs, is over-used in infants even though, in many children, reflux is not an acid-related condition. Moreover, evidence is increasing that PPIs cause adverse events such as gastroenteritis and respiratory tract infections. Management in children older than 10 years is similar to that in adults. Using prokinetics to treat nonerosive reflux disease remains only a promising theoretical concept, as no such molecule is currently available. Today, the adverse effects of each prokinetic molecule largely outweigh its potential benefit. Laparoscopic surgery is indicated in children who have life-threatening symptoms or in cases of drug dependence.
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