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Updated: Jan 5, 2026
Simultaneous Laryngopharyngeal and Conventional Esophageal pH Monitoring
Published on: December 14, 2020
Association between body positioning and gastroesophageal reflux in paediatric age
Paolo Quitadamo1,2, Renato Tambucci3,4, Annalisa Alessandrella1
1Department of Translational Medical Science, Section of Pediatrics, "Federico II" University of Naples, Naples, Italy.
Insights
Postural measures for gastroesophageal reflux (GER) in children and adolescents are often recommended without strong evidence. This study found that upright positions significantly increase reflux episodes and slow acid clearance compared to recumbent positions.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Motility Disorders
Background:
- Postural interventions are commonly advised for managing gastroesophageal reflux (GER) symptoms in pediatric populations.
- However, robust scientific evidence supporting the efficacy of specific body positions for GER management in children and adolescents remains limited.
Purpose of the Study:
- To investigate the impact of upright versus recumbent body positions on gastroesophageal reflux (GER) episodes in pediatric patients.
- To provide data-driven insights into the effectiveness of postural management for GER in children and adolescents.
Main Methods:
- A retrospective analysis of pH-impedance parameters was conducted on 187 pediatric patients (mean age ~7 years) referred for GER symptoms.
- Data were collected from two Italian hospitals between September 2016 and September 2018.
- Patient data were analyzed separately for upright and recumbent positions.
Main Results:
- Acid exposure time remained consistent regardless of body position (P > .05).
- The mean number of reflux episodes per hour was significantly higher in the upright position (2.99) compared to the recumbent position (1.21) (P < .05).
- Mean esophageal acid clearance time was notably shorter in the upright position (44.4 seconds) versus the recumbent position (93.4 seconds) (P < .05).
Conclusions:
- Pediatric patients experience more frequent reflux episodes and prolonged acid exposure in upright positions, likely due to awake-related transient lower esophageal sphincter relaxations.
- These findings offer novel evidence to refine postural recommendations for managing GER in children and adolescents.
Aim:
Postural measures are frequently recommended for gastroesophageal reflux (GER) symptoms, despite limited evidence. This was the first study to assess the impact of upright and recumbent body positions on GER episodes in children and adolescents, not just infants.
Methods:
We retrospectively assessed the pH-impedance parameters of paediatric patients referred for possible GER-related symptoms to two hospitals in Naples and Rome, Italy, from September 2016 to September 2018. Data were separately obtained for the time that the patients spent in upright and recumbent positions.
Results:
Data from 187 patients under the age of 18 were collected, at a mean age of just over seven years. We found that the acid exposure time was stable irrespective of changes in body position (P > .05). The mean number of reflux episodes per hour was 2.99 during the upright position and 1.21 during the recumbent position (P < .05), and the mean oesophageal acid clearance time was 44.4 and 93.4 seconds, respectively (P < .05).
Conclusion:
Most paediatric patients experienced reflux in the upright rather than recumbent position, probably as a result of frequent transient lower oesophageal sphincter relaxations while they were awake. In particular, our findings provide new insights into postural measures for reflux in children and adolescents.
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