If frequent regurgitation presents after 8 weeks of age, please ensure that a urine sample is checked. Young babies may present with a urinary tract infection (UTI) with only vomiting, and being unsettled. Samples should be sent for MC&S as dipstick is not reliable in babies.
UTI guidance can be found here: Urinary Tract Infection in Children – Kingston Hospital
- Review feeding:
- If formula fed, ensure baby is getting the right amount of milk for them, and they are not overfed. (Babies should be getting 120-150mls/kg/day). This is then spread out over 8 feeds a day (as most babies feed 3 hourly).
- If baby is breast fed, arrange a feeding assessment by someone who has appropriate training and expertise in assessing breast feeds.
- Ensure baby is being burped adequately, including in the middle of a feed as well as at the end
- Ensure baby is kept upright after feeding for at least 30mins
- Reinforce the safer sleeping messages – information can be found at The Lullaby Trust www.lullabytrust.org.uk
- Provide parents with appropriate advice and support – this may be via Health Visitor, parent support groups. Assess for postnatal depression (if appropriate). Offer written advice. Reassure that most babies grow out of their reflux symptoms by one year of age.
Some babies may not experience pain or discomfort with reflux, and may just have occasional vomits. In these children Gaviscon or an alternative thickener will be more helpful than Omeprazole.
Gaviscon is still considered as first line treatment for GORD. This however can be very tricky to give to breastfed babies and commonly causes constipation as a side effect.
Gaviscon for children is different from adult Gaviscon as it is works as a thickener as opposed to an anti-acid.
Medicines for Children have a helpful leaflet for parents on gaviscon in babies:
Omeprazole is used as second line treatment. Dosage is outlined in the BNFc under Gastro-oesophageal reflux disease. Omeprazole can take up to 2 weeks to work. Although it reduces the acid in the stomach quickly, it can take around two weeks for any inflammation in the oesophagus to settle. The dose of Omeprazole should be increased as the child gains weight.
Although a syrup suspension of Omeprazole is available, it is not well tolerated as it is very salty, and is not dispensed by most pharmacies. Omeprazole dispersible tablets or MUPS are better tolerated and should be prescribed.
Ensure that when drawing up the Omeprazole after dissolving it that the granules are drawn up and given.
Medicines for Children have produced a helpful leaflet for parents on giving omeprazole: