From the Guidelines

Treatment for gastroesophageal reflux disease (GERD) in infants should focus on reassurance and simple, non-pharmacological interventions.

Frequent regurgitation is common in early infancy and usually resolves by 1 year of age, often not requiring investigation or specific treatment 1.
Red flags such as projectile vomiting, bile-stained vomiting, or systemic features should be identified, as they may indicate more serious conditions 1.

Detailed reassurance is a crucial component of management, given the benign nature of most cases of regurgitation in infants 1.
Minor feed modifications or the use of thickening agents can be considered as simple, non-pharmacological interventions when necessary 1.
Avoidance of acid-suppressing drugs is recommended for isolated overt regurgitation, emphasizing the preference for non-pharmacological management where possible 1.

Upper gastrointestinal contrast radiology should not be used for diagnosing or assessing the severity of GERD, reserving this test for other specific indications like dysphagia or unexplained bile-stained vomiting 1.

From the Research

The majority of cases of gastroesophageal reflux in infants do not require treatment, as the condition is often physiological and self-limiting 2
For frequent and problematic regurgitation, treatment options may include:
- Thickened feedings
- Postural therapy
- Lifestyle changes
Pharmacotherapy may be considered for more severe cases of GERD that do not respond to conservative measures, with proton pump inhibitors being favored over H2-receptor antagonists due to their superior efficacy 2, 3, 4
Antireflux surgery may be indicated for patients with significant GERD who are resistant to medical therapy 2, 5, 6

Lifestyle modifications, such as changes in diet and feeding habits, may be recommended, although the data supporting these recommendations is limited 4
Antacids may be used to treat symptoms, but their effect is short-lived 4
H2-receptor antagonists and proton-pump inhibitors provide more effective options for remission of GERD symptoms and healing of esophagitis 3, 4
Prokinetic medications, such as metoclopramide, have not been proven to be effective in controlling symptoms 4
Baclofen, which inhibits transient lower esophageal sphincter relaxations, may provide an additional option for patients with persistent symptoms, but its use is limited by side effects 4

Antireflux surgery, such as fundoplication, may be effective for patients with significant GERD who are resistant to medical therapy 2, 5, 6
Incisionless laparoscopic fundoplications and newer endoluminal techniques, such as the LINX device, are being used as alternatives to traditional surgical methods 5