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Role of gastro-oesophageal reflux in infant irritability
R G Heine1, A Jaquiery, L Lubitz
1Royal Children's Hospital, Melbourne, Australia, Department of Gastroenterology.
Insights
Gastro-oesophageal reflux (GOR) is unlikely to cause irritability in infants younger than 3 months. Pathological GOR, defined by pH monitoring, was more common in older infants and always accompanied by vomiting.
Area of Science:
- Pediatrics
- Gastroenterology
- Infant Health
Background:
- Gastro-oesophageal reflux (GOR) is a potential cause of excessive crying and irritability in infants.
- Identifying clinical predictors for pathological GOR is crucial for accurate diagnosis and management.
Purpose of the Study:
- To evaluate the role of GOR in infant irritability.
- To define clinical predictors of pathological GOR in infants.
Main Methods:
- Retrospective review of 70 consecutively admitted infants with irritability and presumptive GOR.
- Prolonged oesophageal pH monitoring was used to assess reflux.
- Pathological GOR was defined as fractional reflux time >= 10%.
Main Results:
- Pathological GOR was significantly less common in infants under 3 months (4.2%) compared to older infants (21.7%).
- All infants with pathological GOR experienced frequent vomiting; 'silent' reflux was not observed.
- Poor weight gain, feeding refusal, backarching, and sleep disturbance were not significantly associated with pathological GOR.
Conclusions:
- Pathological GOR is an unlikely cause of irritability in infants under 3 months of age.
- Clinical symptoms like vomiting are key indicators of pathological GOR, not subtle signs.
Abstract:
Gastro-oesophageal reflux (GOR) disease may cause excessive crying in infants. The role of GOR was evaluated in infant irritability and an attempt was made to define clinical predictors of pathological reflux. Seventy consecutively admitted infants with irritability and presumptive GOR were retrospectively reviewed. All had undergone prolonged oesophageal pH monitoring. Pathological GOR was defined as a fractional reflux time of > or = 10% and was significantly less common in infants under 3 months (one of 24; 4.2%) than in older infants (10 of 46; 21.7%). All infants with pathological GOR presented with frequent vomiting, and 'silent' pathological reflux did not occur. Poor weight gain, feeding refusal, backarching, and sleep disturbance were not significantly associated with pathological GOR. The results suggest that pathological GOR is an unlikely cause of infant irritability under the age of 3 months.