Paeds · gastroenterology-hepatology-and-nutrition
Gastro-oesophageal reflux and reflux disease
Also known as GOR and GORD · Gastro-oesophageal reflux disease in children · Infant reflux and posseting · Paediatric acid reflux · Reflux oesophagitis in children
Fellowship guide to paediatric gastro-oesophageal reflux and reflux disease — how to separate the physiologic reflux of the happy spitter from the disease that harms, the transient-sphincter-relaxation pathophysiology, the conservative-first stepwise ladder that keeps children off unnecessary acid suppression, and the red flags that turn reflux into a surgical or allergic emergency.
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Target exams
Red flags
- Bilious (green) vomiting is never reflux — it is malrotation or intestinal obstruction until proven otherwise and demands urgent upper gastrointestinal contrast imaging
- Forceful projectile vomiting at three to six weeks is pyloric stenosis, not GORD — palpate the pyloric tumour and check for hypochloraemic alkalosis
- Reflux that begins after six months or persists beyond the first birthday is atypical and should prompt a search for another cause
- Haematemesis, faltering growth, or recurrent aspiration signals disease, not physiologic reflux, and warrants investigation and treatment
- Acid suppression started for crying, back-arching, or apnoea without proven oesophagitis exposes the child to infection and fracture risk for no benefit
- A reflux label that delays a septic, surgical, neurological, or metabolic work-up in a vomiting child is the dangerous error — exclude the mimics first
Life stages
Care settings
Clinical exam formats
Board mappings
- General and Community Paediatrics
- Gastroenterology
- Gastro-oesophageal reflux and reflux disease
- Paediatric gastroenterology competencies
- Recognition and stepwise management of gastro-oesophageal reflux disease
- Current 2026 PREP curriculum — reflux and rational acid-suppression prescribing
- Clinical Applications
- Conservative-first management of paediatric gastro-oesophageal reflux
- Long and Short Cases
- Gastrointestinal and feeding scenarios
- 1. Good clinical care: Managing complexity
- Gastroenterology: Recognises and manages gastro-oesophageal reflux disease in children
- Foundation of Practice (FOP)
- Applied Knowledge in Practice (AKP)
- Gastroenterology, hepatology and nutrition
- Clinical
- History-taking and management planning
- Communication
- General Pediatrics Content Outline — Gastrointestinal disorders
- General Pediatrics EPA: Manage the child with reflux
- Patient Care: Paediatric gastrointestinal disorders
- Medical Knowledge: Gastro-oesophageal physiology and reflux
- Systems-Based Practice: conservative-first, evidence-based prescribing
- Medical Expert
- Paediatric gastrointestinal management
- Pediatrics Core EPA — Managing gastro-oesophageal reflux disease
Overview & Definition
Few paediatric labels are applied as loosely, or as often, as "reflux". Every posset, every unsettled evening, and every back-arch after a feed attracts the word, and much of time word is wrong. The discipline this topic teaches is judgement: telling the common, harmless, self-limiting reflux of a thriving baby from the disease that genuinely harms, and refusing the reflex prescription of an acid-suppressing drug the evidence does not support. [1]
Gastro-oesophageal reflux, or GOR, is the effortless retrograde movement of gastric contents into the oesophagus, with or without regurgitation into the mouth. In infants it is the physiological norm rather than the exception, driven by an immature anti-reflux barrier and a liquid diet, and it resolves as the child sits, walks, and moves to solid food. Gastro-oesophageal reflux disease, GORD, is the term reserved for reflux that produces troublesome symptoms or complications, and separating the two is the single most important judgement you make at the cot-side and in clinic. [1]
The vocabulary matters because examiners test it. Regurgitation is the visible return of gastric contents into the pharynx or mouth, and posseting is the small, effortless bringing up of milk. Vomiting is different — it is forceful and involves coordinated muscular effort, and a forceful or projectile vomit is a surgical symptom until proven otherwise. Rumination and cyclical vomiting are distinct entities that masquerade as reflux and must be recognised on their own terms. [1]
References11ShowHide
- [1]Rosen R, Vandenplas Y, Singendonk M, et al Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr, 2018.PMID 29470322
- [2]Tighe MP, Andrews E, Liddicoat I, et al. Pharmacological treatment of gastro-oesophageal reflux in children. Cochrane Database Syst Rev, 2023.PMID 37635269
- [3]van der Pol RJ, Smits MJ, van Wijk MP, et al Efficacy of proton-pump inhibitors in children with gastroesophageal reflux disease: a systematic review. Pediatrics, 2011.PMID 21464183
- [4]Salvatore S, Ripepi A, Huysentruyt K, et al The Effect of Alginate in Gastroesophageal Reflux in Infants. Paediatr Drugs, 2018.PMID 30182358
- [5]Orenstein SR, Hassall E, Furmaga-Jablonska W, et al Multicenter, double-blind, randomized, placebo-controlled trial assessing the efficacy and safety of proton pump inhibitor lansoprazole in infants with symptoms of gastroesophageal reflux disease. J Pediatr, 2009.PMID 19054529
- [6]Banderali G, Mameli C, Bozzola E, et al Efficacy and safety of non-pharmacological interventions for gastroesophageal reflux and gastroesophageal reflux disease in children: a systematic review. Ital J Pediatr, 2026.PMID 42098776
- [7]Eichenwald EC Diagnosis and Management of Gastroesophageal Reflux in Preterm Infants. Pediatrics, 2018.PMID 29915158
- [8]Nelson SP, Chen EH, Syniar GM, et al Prevalence of symptoms of gastroesophageal reflux during infancy. A pediatric practice-based survey. Pediatric Practice Research Group. Arch Pediatr Adolesc Med, 1997.PMID 9193240
- [9]Nelson SP, Chen EH, Syniar GM, et al One-year follow-up of symptoms of gastroesophageal reflux during infancy. Pediatric Practice Research Group. Pediatrics, 1998.PMID 9832595
- [10]Puoti MG, Assa A, Benninga M, et al Drugs in Focus: Domperidone. J Pediatr Gastroenterol Nutr, 2023.PMID 37159421
- [11]King E, Horn D, Gluchowski N, et al Safety and efficacy of proton pump inhibitors in preterm infants with gastroesophageal reflux disease. Cochrane Database Syst Rev, 2025.PMID 40066936