| Understanding Gastro-oesophageal reflux in infants |
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Dear Healthcare Professional,
Welcome to the June edition of our eNewsletter aimed to keep you updated with the latest news in infant nutrition.
Reflux and regurgitation is our topic of the month and we will highlight useful information about reflux and regurgitation in infants. We would also like to introduce you to our new anti-reflux formula, SMA® PRO Anti-Reflux which will be launching in July! Finally we will summarize the 2015 NICE guidelines to freshen up your knowledge on managing gastro-oesophageal reflux in infants to help you in your healthcare professional roles.
Kind regards,
The SMA® Professional Team |
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| Gastro-oesophageal reflux (GOR) is a normal physiological process in healthy infants. It is the involuntary passage of gastric contents from the stomach into the oesophagus, and when the reflux is high enough to be seen it is known as regurgitation1, 2. Regurgitation occurs daily in about 50% of infants under 3 months of age1 and is primarily due to functional immaturity of the stomach inlet3. Symptoms peak at 4 months, usually resolve by 12–15 months4 and do not require further specialist assessment1, 5.
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| NICE guidance for managing infant reflux and regurgitation |
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In 2015, the National Institute for Health and Care Excellence (NICE) recommended the following measures for managing formula-fed infants with frequent regurgitation associated with marked distress5:
1.Offer parental reassurance
2.Review feeding history, suggest smaller more frequent feeds (while maintaining appropriate daily milk volume intakes)
3.Trial of a thickened formula
4.If a thickened formula does not work, stop the thickened formula and offer alginate therapy for a trial period of 1–2 weeks.
In infants with vomiting or regurgitation, look out for ‘red flag’ symptoms, such as blood in stool, persistent diarrhoea or abdominal distension which may suggest a more serious condition. |
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® Registered Trademark.
IMPORTANT NOTICE: The World Health Organisation (WHO) has recommended that pregnant women and new mothers be informed on the benefits and superiority of breast-feeding – in particular the fact that it provides the best nutrition and protection from illness for babies. Mothers should be given guidance on the preparation for, and maintenance of, lactation, with special emphasis on the importance of a well-balanced diet both during pregnancy and after delivery. Unnecessary introduction of partial bottle-feeding or other foods and drinks should be discouraged since it will have a negative effect on breast-feeding. Similarly, mothers should be warned of the difficulty of reversing a decision not to breast-feed. Before advising a mother to use an infant formula, she should be advised of the social and financial implications of her decision: for example, if a baby is exclusively bottle-fed, more than one can (400 g) per week will be needed, so the family circumstances and costs should be kept in mind. Mothers should be reminded that breast-milk is not only the best, but also the most economical food for babies. This product must be used under medical supervision. SMA® PRO Anti-Reflux is a special formula intended for the dietary management of bottle-fed babies when significant reflux (regurgitation) is a problem. It is suitable as the sole source of nutrition up to 6 months of age, and in conjunction with solid food up to 12 months of age. If the baby’s reflux does not improve within 2 weeks of starting SMA® PRO Anti-Reflux, or if the baby fails to thrive, the family doctor should be consulted.
References: 1. Vandenplas Y, Rudolph CD, Di Lorenzo C, et al. J Pediatr Gastroenterol Nutr 2009; 49:498–547 2. Benninga M and Nurko, S et al. Gastroenterology 2016;150:1443-1455. 3. Fonkalsrud EW. Curr Probl Surg 1996; 33(1): 1–70. 4. Hegar et al. Acta Pediatr 2009; 98: 1189–1193 5. NICE Gastro-oesophageal reflux disease: recognition, diagnosis and management in children and young people, 2015. Available here. Accessed May 2017. 6. Aptamil Anti-Reflux and Cow & Gate Anti- Reflux datacards. Available here. Accessed March 2017 7. Hipp Organic anti-reflux datacard. Available here. Accessed March 2017. 8. Enfamil AR datacard. Available at www.nutramigen.ie/hcp. Accessed March 2017. 9. SMA® PRO Anti- Reflux data card. Available here. Accessed March 2017. |
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