Diagnosing GERD in Infants
Clinical Features to Assess
- The American Academy of Pediatrics recommends that common symptoms of GERD in 12-month-old infants include regurgitation or vomiting, irritability, feeding refusal or anorexia, poor weight gain, sleep disturbance, and respiratory symptoms, such as coughing, choking, or wheezing 3, 2
- The prevalence of GERD decreases with age, affecting only 5-10% of infants by 12 months of age, according to the American Academy of Pediatrics 3
Warning Signs Requiring Further Investigation
- The American Academy of Pediatrics and the American Family Physician recommend that warning signs, such as bilious vomiting, gastrointestinal bleeding, consistently forceful vomiting, fever or lethargy, hepatosplenomegaly, bulging fontanelle, macro/microcephaly, seizures, abdominal tenderness or distension, and genetic/metabolic syndrome, require further investigation 1, 2
Diagnostic Testing (When Indicated)
- The American Academy of Pediatrics recommends that upper GI tract series, esophageal pH monitoring, upper endoscopy with biopsy, and impedance monitoring be considered when warning signs are present or diagnosis is uncertain 1, 5, 2
- Routine upper GI tract radiography is not justified for GERD diagnosis, as studies are too brief and may lead to false-positive diagnoses, according to the American Academy of Pediatrics 5
Differential Diagnosis Considerations
- Pyloric stenosis, characterized by persistent forceful vomiting, and malrotation or duodenal web, characterized by bilious vomiting, should be considered in the differential diagnosis, according to the American Academy of Pediatrics 5
Validated Assessment Tools
- The American Academy of Pediatrics recommends using validated GERD symptom questionnaires, such as the Kleinman questionnaire, to document and monitor parent-reported GERD symptoms in infants 1