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Gastro-oesophageal reflux is increasingly being diagnosed with a range of symptoms from vomiting after eating food through to failure to thrive and upper and lower airway manifestations such as aspiration, cough, sinusitis, laryngitis and possibly middle ear disease.  

There are four types of gastro-oesophageal reflux in children including their physiologic reflux which is usually asymptomatic with occasional vomiting in children, a silent reflux which can only be confirmed by special PH monitoring, pathologic reflux which can interfere with growth and cause respiratory complications and secondary reflux which is related to problems such as neurologic or anatomical abnormality of the oesophagus.  Respiratory complications of reflux may include bronchitis, pneumonia, croup and chronic asthma.  The investigation of gastro-oesophageal reflux includes a history, possible barium examination, PH testing or endoscopic examination of the oesophagus and stomach.

The management of this condition in children may include lifestyle modifications and medication treatment or anti reflux surgery with the severity of the reflux determining the level of treatment.  Conservative methods may include elevating the head of the bed, frequent small feeds, thickening of the child’s milk and fasting before bedtime.  There are a number of medications which may be successful to reduce the secretion of stomach acid and surgical intervention including nissen fundoplication may be necessary on occasion.

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