Gastroesophageal Reflux Disease (GERD) in Children Initial Assessment

Clinical Presentation

For those infants <12 months of age, patients suffering from GERD may present with refusal to eat, recurrent vomiting, poor weight gain, irritability, and/or sleep disturbance. Patients ≥1 year of age, may present with abdominal pain or heartburn, recurrent vomiting, dysphagia, asthma, recurrent pneumonia, respiratory symptoms (eg coughing, wheezing, choking), and/or upper airway symptoms (eg prolonged or chronic cough, hoarseness).  

GERD in Children_Initial Assessment 1

GERD in Children_Initial Assessment 2

• Gastrointestinal (GI) tract bleeding (eg hematemesis, hematochezia)
• Abdominal tenderness/distension
• Palpable abdominal mass
• Bilious vomiting
• Projectile vomiting
• Fever
• Lethargy
• Irritability
• Hepatosplenomegaly
• Seizures
• Bulging fontanelle
• Positive for genetic or metabolic syndrome

History

Since GERD occurs with few, if any, abnormal physical findings, a well-taken history is essential in establishing the diagnosis of GERD in children.  

Diagnosis or Diagnostic Criteria

It must be noted that there is no gold standard for the diagnosis of GERD. Diagnostic tests are used to document pathologic reflux and presence of complications. Thorough history and physical examination may be sufficient to distinguish uncomplicated from complicated GER in infants and children with recurrent regurgitation. Infants with recurrent regurgitation but with poor weight gain should undergo thorough history and physical examination with laboratory exams (eg complete blood count [CBC], serum electrolytes, blood urea nitrogen [BUN], serum creatinine) to rule out other possible etiologies of the symptoms. Infants in unexplained state of distress with constant crying bouts should be investigated for diseases other than GERD as reflux is not a common cause for these symptoms.