Gastro-oesophageal reflux in infancy

Gastro-oesophageal reflux is very common in infancy. In most cases it is benign. It is important to differentiate physiological reflux from gastro-oesophageal reflux disease, which is gastro-oesophageal reflux with significant morbidity. This review summarizes the approach to infants with symptoms and signs of reflux, differential diagnosis, investigations with their limitations and non-pharmacological, pharmacological and surgical treatment. Most infants with gastro-oesophageal reflux do not need further investigation or medical management providing the infant is thriving. Severe cases require a careful diagnostic work up and consideration of the differential diagnoses, treatment of associated conditions and aggressive medical management of the reflux. Involvement of the multidisciplinary team is essential and in reflux resistant to standard medical management surgical intervention needs to be considered. A trial of a hydrolyzed milk protein formula may be beneficial in such cases.