GPAtlas🧭 When to suspect
Gastro-oesophageal reflux (GOR) – the effortless passage of stomach contents up into the oesophagus – is a normal physiological process in infancy. It affects at least 40% of infants, typically begins before 8 weeks of age, and resolves in around 90% before the first birthday. These thriving, contented babies are often called "happy spitters" and need reassurance and feeding advice, not investigation or medication.
Gastro-oesophageal reflux disease (GORD) is reflux that causes troublesome symptoms or complications – marked distress, feeding difficulty, faltering growth, or oesophageal/respiratory sequelae. In children and young people over 1 year, GORD looks more like the adult picture: heartburn, retrosternal or epigastric pain, and acid regurgitation.
The central primary-care skill is to separate physiological GOR from GORD, exclude the red-flag mimics (a green vomit or a projectile vomit is never simple reflux), and step up management proportionately – most cases never need a prescription.
| Feature | GOR (gastro-oesophageal reflux) | GORD (reflux disease) |
|---|---|---|
| Nature | Normal physiological event | Reflux causing distressing symptoms or complications |
| Infant picture | Content, thriving "happy spitter" | Marked irritability, back-arching, feeding refusal, faltering growth |
| Natural history | Onset < 8 weeks; resolves in ~90% by 1 year | May persist; red flag if onset > 6 months or continuing beyond 1 year |
| Older child (> 1 yr) | Usually outgrown | Heartburn, retrosternal/epigastric pain, acid regurgitation |
| Primary-care action | Reassure + feeding advice; no investigation | Optimise feeding → stepped treatment → refer if needed |
|
🧠 Clinical pearl Non-IgE cow's milk protein allergy (CMPA) is the great mimic of GORD. Suspect it when reflux is unusually distressing or simply will not settle, especially alongside eczema, a strong atopic family history, chronic diarrhoea, or blood/mucus in the stool – and trial an extensively hydrolysed formula (or maternal dairy exclusion if breast-fed) before escalating acid suppression. |
Source: NICE NG1
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