Version July 2025
GERD: gastroesophageal reflux disease; GI: gastrointestinal; pH-MII: esophageal pH and multichannel intraluminal impedance.
* Symptoms that suggest possible esophageal pain include posturing (arching and neck turning, known as Sandifer syndrome), irritability that is temporally related to feeds or reflux episodes, or (rarely) feeding refusal. For these infants, options include an empiric trial of acid-suppressing medication, a pH-MII study to assess for correlation between symptoms and reflux, and/or upper endoscopy to evaluate for esophagitis.
¶ Predisposing conditions that may lead to GERD-related respiratory symptoms include neurologic problems that cause swallowing dysfunction, anatomic anomalies that cause aspiration (eg, laryngotracheal cleft or tracheoesophageal fistula), and/or esophageal dysmotility.
Δ The timing of this evaluation depends on severity of associated symptoms. If symptoms are not severe, it is reasonable to proceed to empiric treatment for GERD, with close follow-up and further evaluation if needed.
◊ Laboratory testing is indicated for infants with poor weight gain and should include stool testing for occult blood, complete blood count, electrolytes, and a review of newborn screening tests. In older infants who have been exposed to wheat, rye, or barley, serologic screening for celiac disease should be performed. In selected cases with severe delays in weight gain, growth, or other concerning symptoms, additional evaluation for genetic or metabolic diseases may be indicated.
§ A limited trial of acid-suppressing medication is approximately 2 weeks. If these infants have an unequivocal improvement in symptoms, acid suppression may be continued for 3 to 6 months, followed by reevaluation. For infants with endoscopically confirmed moderate or severe esophagitis, acid suppression is given for 3 to 6 months, followed by reevaluation.
