A Primary Care Perspective

This clinical paper discusses the role of the pediatric nurse in the evaluation and management of gastroesophageal reflux (GERD) in infants. During an infant’s first year of life, GER is a common occurrence and concern of families. The infant with uncomplicated GER may be managed conservatively with feeding schedule modifications, thickened feeds, changes in positioning, or a trial of formula change. Gastroesophageal reflux disease (GERD) is a pathological process in infants manifested by poor weight gain, signs of esophagitis, persistent respiratory symptoms or complications, and changes in neurobehavior. Management of the infant with GERD, in addition to non-pharmacological interventions, involves further diagnostic evaluation and pharmacologic therapy, depending upon the child’s history and clinical presentation. While most cases of GER are self-limiting, complications include esophagitis, bronchospasm, apnea, aspiration pneumonia and other otolaryngologic disorders. The pediatric health care provider should offer an ongoing, comprehensive clinical approach to the family based on considerations of growth and development, and the quality of interactions between the caregivers and child.Gastroesophageal reflux (GER), defined as the passage of gastric contents into the esophagus, is one of the most common gastrointestinal problems in infants and affects about 50% of healthy, full-term newborns (Jadcherla & Shaker, 2001). Postprandial regurgitation is the most common sign of GER in infants and may range from effortless spitting to forceful vomiting (Sondheimer, 2003). It is common for the pediatric nurse to be approached with questions and concerns from families about GER. In most cases, anticipatory guidance and teaching regarding the natural occurrence of GER and the many non-pharmacological approaches to managing GER are enough to allow for normal growth and development of the child and place the family at ease. Nevertheless, the pediatric nurse should also be able to distinguish GER from gastroesophageal reflux disease (GERD), which is a pathologic process in infants associated with poor weight gain, signs of esophagitis, persistent respiratory problems, dysphagia, and changes in neurodevelopmental patterns.