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The benefits of nonpharmacologic therapy for infant GERD.
Modification of feeding practices and positioning, along with tobacco smoke avoidance, can greatly reduce infant symptoms of gastroesophageal reflux disease (GERD), according to a recent report.
These findings were demonstrated in 37 infants recruited from five US outpatient general pediatric sites who were diagnosed clinically with GERD and had an abnormal score on the parent-completed Infant Gastroesophageal Reflux Questionnaire Revised (I-GERQ-2). The 12-item questionnaire pertains to regurgitation, crying, feeding refusal, apnea/cyanosis, hiccups, and arching. Each site's study nurse counseled parents on conservative measures that might improve these symptoms.
Two weeks after being counseled, parents returned to the sites with their infants to undergo assessments. I-GERQ-2 scores had improved for 78% of infants after undergoing recommended conservative therapy. In fact, scores were normal for 24% of them. Improvement was particularly significant for symptoms related to regurgitation, crying, and arching (Orenstein SR et al: J Pediatr 2008;152:310).
I like this approach to GERD: clinical diagnosis without invasive procedures, and symptomatic treatment without medication. If the patient fails to improve with these measures, a more aggressive plan might be warranted. But if these findings are correct, this next step will be unnecessary for many young patients.