Pediatric Gastroesophageal Reflux Guidelines

Updated: Mar 14, 2019
  • Author: Steven M Schwarz, MD, FAAP, FACN, AGAF; Chief Editor: Carmen Cuffari, MD  more...
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Clinical practice guidelines on pediatric gastroesophageal reflux by the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) recommend the following [23, 24] :

  • Four to eight weeks of acid-suppression therapy is recommended to treat typical reflux symptoms. This should only occur after dietary modifications in infants are unsuccessful.
  • Avoid acid suppression in infants and children with extraesophageal symptoms (eg, cough, wheezing, asthma).
  • GERD complications should be assessed with esophagogastroduodenoscopy (EGD) with biopsies.
  • pH/impedance studies are recommended to see the role of acid reflux in esophagitis and whether acid-suppression therapy was effective.
  • Diagnosing GERD with salivary pepsin, extraesophageal biomarkers, and scintigraphy is not recommended.
  • Only use manometry if there is suspicion of an underlying motility disorder.
  • Positional therapy to treat reflux in infants is not recommend.
  • Proton pump inhibitors can be used as treatment for erosive esophagitis.