Referral criteria
Where an infant does not respond to these measures or where initial presenting symptoms are worrying, the child should be referred to their GP for investigation. Simple measures include the use of an alginate-antacid to thicken feeds and neutralise stomach acid. Gaviscon Infant sachets can be added to formula and expressed breast milk up to a maximum of six times per day. They are a P medicine but should only be used under medical supervision for infants under one year. For more serious or intractable symptoms the GP may recommend an H2 antagonist or proton pump inhibitor, although this would be off-licence use.
When to refer infants with reflux
- Severe or prolonged vomiting
- Haematemesis (blood in vomit)
- If fever is present
- If cow's milk protein allergy is suspected as a cause of reflux
- When the infant does not respond to practical measures to reduce reflux
- If an anti-reflux formula is used without improvement in symptoms
- If infant has a distended abdomen following use of anti-reflux formula
- If constipation is a problem
- If infant is refusing feeds
- If infant is losing weight or is failing to thrive