Takeaway
- The 2018 pediatric GERD guidelines stand out for taking a “question-based” approach, offering diagnostic and therapeutic algorithms for infants and children and suggesting a trial of acid suppression in older children.
Why this matters
- This JAMA Pediatrics guidelines synopsis offers a quick-reference pocket version of the major recommendations from the guidelines.
Key recommendations
- Avoid barium contrast studies, esophagogastroduodenoscopy, manometry to diagnose.
- Wean after 4-8 weeks of optimal drug management, regardless of response.
- Infants: try feeding modifications (volume, frequency, hydrolyzed protein formula).
- No positional therapy in sleeping infants.
- No gastroesophageal reflux disease (GERD) meds for crying, regurgitation in otherwise healthy children.
- Avoid GERD meds with extraesophageal symptoms.
- Proton pump inhibitors, histamine receptor antagonists: both carry risks, adverse effects to consider.
- Formula thickeners: continued breastfeeding recommended; effects of thickening on nonregurgitation are unclear, and arsenic in rice cereals is a concern; severe bowel complications are a concern with commercial thickeners (e.g., xanthan gum).
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