From the Guidelines
Gastroesophageal reflux (GER) in a two-month-old can typically be managed with conservative measures before considering medication, focusing on lifestyle modifications and feeding changes to reduce symptoms and improve quality of life. The most recent and highest quality study 1 emphasizes the importance of nonpharmacologic management of GER in infants, including avoiding overfeeding, frequent burping during feeding, upright positioning in the caregiver’s arms after feeding, and avoidance of secondhand smoke.
Some key considerations for managing GER in infants include:
- Feeding changes, such as modifying maternal diet in breastfed infants and changing formula in formula-fed infants, to reduce symptoms and improve digestion 1
- Reducing feeding volume while increasing feeding frequency to decrease stomach distension and pressure 1
- Thickening feedings with commercially thickened formula for infants without milk-protein intolerance to decrease the frequency of regurgitation, although this may not alter esophageal acid exposure 1
- Upright positioning and frequent burping to help reduce reflux episodes and improve symptoms 1
Medications, such as H2 blockers or proton pump inhibitors, are rarely needed for infant reflux and should only be considered if symptoms are severe and conservative measures have failed. The study by Wenzl et al 1 highlights the potential risks of acid suppression therapy in infants, including an increased risk of pneumonia or gastroenteritis, and recommends a moderate approach to treatment.
It is essential to note that most infants outgrow reflux by 12-18 months as their digestive systems mature and they spend more time upright. If your baby shows poor weight gain, feeding refusal, breathing difficulties, or persistent crying despite conservative measures, it is crucial to contact your pediatrician for further evaluation and guidance.
From the Research
Treatment of Gastroesophageal Reflux in Infants
To treat gastroesophageal reflux (GER) in a two-month-old infant, the following approaches can be considered:
- For non-complicated reflux, no intervention is required for most infants, and effective parental reassurance and education regarding regurgitation and lifestyle changes are usually sufficient to manage infant reflux 2.
- Conservative treatment and thickened formula can be helpful for treating gastroesophageal reflux disease (GERD) 3.
- Feeding schedule modifications, thickened feeds, changes in positioning, or a trial of formula change can be used to manage GER in infants 4.
- Nonpharmacologic measures should be used whenever possible because most infant GER will resolve without intervention 5.
Pharmacological Interventions
Pharmacological interventions may be considered in certain cases:
- Antisecretory agents, antacids, surface barrier agents, and prokinetics can be used to treat GERD, but the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) and European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) practice guidelines concluded that there is insufficient evidence to justify the routine use of prokinetic agents 2.
- Proton pump inhibitors (PPIs) are frequently prescribed for treating reflux, but studies do not show a definite benefit in infants, and there are potential side effects 3.
- Esomeprazole (Nexium) is approved in the US for short-term treatment of GERD with erosive esophagitis in infants aged from 1 to 12 months 2.
Diagnostic Evaluation
A thorough history and physical examination with attention to warning signals suggesting other causes is generally sufficient to establish a clinical diagnosis of uncomplicated infant GER 2.
- Upper GI (UGI) study has low sensitivity and specificity and should not be ordered as a diagnostic test for reflux, but can be used to evaluate other anatomic causes of vomiting 3.
- Upper endoscopy is considered for children with concerning symptoms, persistent symptoms despite treatment, and relapse of symptoms after treatment 3.