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As a paediatric registrar you are presented with a 4-month-old baby in paediatric outpatients. His mum describes him as having large vomits up to 30 min after most feeds, and recently he has seemed reluctant to feed. He is exclusively breast fed, and is gaining weight appropriately and otherwise thriving. He has previously been investigated for his vomiting and you conclude that he has gastroeosphageal reflux without complications (GOR).
In the first instance, positioning and thickened, small frequent feeds would be advised. The latter suggestion is not without difficulty for mothers exclusively breast feeding. As the mother is describing vomiting at least six times per day, but no signs suggestive of pain at present, could a pro-kinetic alone such as domperidone improve these symptoms?
Structured clinical question
For infants with symptoms of GOR [patient], is domperidone [intervention] as effective as or more effective than standard therapy [comparison] at improving symptoms [outcome]?
Medline (1948–March 2011) and Embase (1947–March 2011) were searched using the keywords (infant or child) and (gastro-oesophageal reflux or gastro-oesophageal reflux) and (domperidone or Motilium), limited to the English language.
The Cochrane Database of Systematic Reviews was also searched.
A total of 137 articles were found of which seven were relevant: six papers were identified after review of abstracts, and a …