Gastro-oesophageal reflux disease (GORD) in Children

🔍 When to Suspect

Infants with frequent regurgitation causing marked distress, feeding difficulty, or poor weight gain (GORD), or older children with heartburn, regurgitation, or epigastric pain

From the full topic in The Ocean Library: Gastro-oesophageal reflux disease (GORD) in Children

🧭 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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