Selections from Journal Watch Pediatrics and Adolescent Medicine Copyright © 2005 Massachusetts Medical Society. All rights reserved.

Reflux in infants: new data, old treatments ▸

Most infants outgrow gastroesophageal reflux (GER). However, some infants (and their families) need an active approach to this normal developmental phenomenon. A recent Cochrane Collaboration review focused on randomized clinical trials that evaluated thickened feeds, positional changes, and metoclopramide for GER treatment in infants aged 1 month to 2 years. The authors identified 20 trials involving 771 infants (8 evaluating thickened feeds; 5, positioning; 7, metoclopramide), but differences in trial design made comparison difficult. Most of the reported findings are based on a few studies.

Thickened feeds significantly reduced GER severity scores (2 studies) and frequency of emesis (3 studies), but had no effect on the reflux index (RI; percent of time that pH is <4.0; 2 studies). Elevating the head of the bed (5 studies) had no effect on esophageal pH, the primary outcome measure. Metoclopramide significantly improved daily symptoms (2 studies) and the RI score (2 studies), but had no effect on the number of reflux episodes lasting more than 5 minutes or the number of low-pH episodes (2 studies).