New guidelines call for less medical intervention for infant reflux

Spitting up food is common for babies, but how much is too much?

New guidelines released yesterday from the American Academy of Pediatrics call for pediatricians to differentiate between gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD) in infants before recommending specialized treatment.

What’s Normal?
According to the report, GER occurs in “more than two-thirds of otherwise healthy infants, and is the topic of discussion with pediatricians at one-quarter of all routine 6-month infant visits.”

The report goes on to say that parents too often seek evaluation for GER by a specialist.  GER should not affect growth or cause pain.  In short, according to the guidelines, all infants are going to have some reflux.  Therefore, visiting a specialist is not a recommended course of treatment for babies who have GER.

“All babies are going to have some amount of reflux—one to two teaspoons, and occasionally even a little more than that is normal,” says Dr. Jon Pascua, a pediatric hospitalist at Advocate Condell Medical Center in Libertyville, Ill.

When it comes to GER, the report urges pediatricians to focus on “minimal testing and conservative management” that might include parental education rather than a course of medication or diagnostic testing for the child.

A More Serious Issue
But, according to the new guidelines, GERD can be more dangerous.

“It is important that all practitioners who treat children with reflux-related disorders are able to identify and distinguish those children with GERD…from those with simple GER,” states the report.

Infants with GERD may benefit from further evaluation and treatment, according to the new guidelines.

“It’s important that parents realize that GER is different than GERD,” says Dr. Pascua.  “In babies with GERD, you see larger amounts of their food being regurgitated consistently, and over time you would see poor weight gain and even discomfort with food because GERD can irritate their esophagus.”