Allen K, Davidson G, Day A Management of cow's milk protein allergy in infants and young children: an expert panel perspective. J Paediatr Child Health. 2009; 45:(9)481-6

Banna H, Jutel A Gastro-esophageal reflux in breastfed babies: What's missing?. New Zealand College of Midwives Journal. 2013; 48:9-14

Bhavsar H, Cullen M, Beattie R Gastro-oesophageal reflux in infancy. Paediatr Child Health. 2011; 21:(9)394-400

Corvaglia L, Martini S, Faldella G Gastro-oesophageal reflux: pathogenesis, symptoms, diagnostic and therapeutic management. Early Human Development. 2013; 89:S18-9

Cremonesini L Gastro-oesophageal reflux in infants: A common concern for parents. Journal of Health Visiting. 2014; 2:(4)188-92

London: DH; 2009

Dogra H, Lad B, Sirisena D Paediatric gastro-oesophageal reflux disease. British Journal of Medical Practitioners. 2011; 4:(2)412-5

Entwistle F The evidence and rational for the UNICEF UK Baby Friendly Initiative standards.UK: UNICEF; 2013

Ferreira C, Carvalho E, Sdepanian V Gastroesophageal reflux disease: exaggerations, evidence and clinical practice. J Pediatr. 2014; 90:(2)105-18

Hassall E Decisions in diagnosing and managing chronic gastroesophageal reflux disease in children. J Paediatr. 2005; 146:(3)S3-12

Huang R, Forbes D, Davies M Feed thickener for new-born infants with gastro-oesophageal reflux. Cochrane Database Syst Rev. 2009; 3

Hyman P, Milla P, Benninga M Childhood functional gastrointestinal disorders: neonate/toddler. Gastroenterology. 2006; 130:1519-26

Jung AD Gastroesophageal reflux in infants and children. American Family Physician. 2001; 64:(11)1853-60

Mir N Managing gastro-oesophageal reflux in infants. BMJ. 2010; 27:(341)

: National Institute for Health and Care Excellence; 2014

London: NICE; 2015

Nelson S, Chen E, Synair G Prevelence of symptoms of gastro-oesophageal reflux during infancy: a paediatric-based survey. Archives of Pediatrics and Adolescent Medicine. 1997; 151:569-72

London: NMC; 2012

Omari T, Barnett C, Benninga M Mechanisms of gastro-oesophageal reflux in preterm and term infants with reflux disease. Gut. 2002; 51:(4)475-9

Perrio M, Voss S, Shakir S Application of the Bradford hill criteria to assess the causality of cisapride-induced arrhythmia: a model for assessing causal association in pharmacovigilance. Drug Saf. 2007; 30:(4)333-46

Poets C, Brockmann P Myth: Gastroeosophageal reflux is a pathological entity in the preterm infant. Seminars in Fetal and Neonatal Medicine. 2011; 16:259-63

Radesky J, Zuckerman B, Silverstein M Inconsolable infant crying and maternal postpartum depressives symptoms. Pediatrics. 2013; 131:(6)e1857-64

Raynor M, England CBerkshire: Open University Press; 2010

Richards R, Foster J, Psaila K Continuous versus bolus intragastric tube feeding for preterm and low birth weight infants with gastro-oesophageal reflux disease. Cochrane Database Syst Rev. 2014; 7

Roth C, Dunn J, Phillips D Reducing neonatal admissions from home to the children's ward. British Journal of Midwifery. 2010; 18:(12)772-8

Scholler I, Nittur S Understanding failure to thrive. Paediatrics Child Health. 2012; 22:(10)438-42

Sherman P, Hassall E, Fagundes-Neto U A global evidence-based consensus on the definition of gastroesophageal reflux disease in the pediatric population. American Journal of Gasteroenterology. 2009; 104:(5)1278-95

Tighe M, Afzal N, Bevan A Pharmacological treatment of children with gastro-oesophageal reflux. Cochrane Database Syst Rev. 2014; 11

Van-Wijk M, Benninga M, Dent J Effect on body position changes on postprandial gastroesophageal reflux and gastric emptying in the healthy premature neonate. J Pediatr. 2007; 151:(6)585-90

Vandenplas Y, Rudolph D, Di Lorenzo C NASPGHAN-ESPGHAN guidelines. Pediatric gastroesophageal reflux clinical practice guidelines: joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). J Pediatr Gastroenterol Nutr. 2009; 49:(4)498-547

Viera M, Miyague N, Van Steen K, Salvatore S, Vandenplas Y Effects of domperidone on QTc interval in infants. Acta Paediatr. 2012; 101:(5)494-6

World Health Organization. Ten facts on breastfeeding. 2011. (accessed 8 April 2015)

Ystrom E Breastfeeding cessation and symptoms of anxiety and depression: a longitudinal cohort study. BMC Pregnancy Childbirth. 2012; 12

Gastro-oesophageal reflux in the neonate: Clinical complexities and impact on midwifery practice

02 May 2015
Volume 23 · Issue 5


Gastro-oesophageal reflux (GOR) is a common neonatal issue seen by midwives, which can develop into a complex clinical picture when symptoms give rise to gastro-oesophageal reflux disease (GORD), requiring further intervention and multidisciplinary team working. This article discusses the differences between GOR and GORD from a midwifery stance, highlighting the importance of effective communication with parents, and within the wider health-care professions.

Early midwifery recognition and symptom clarity for both GOR and GORD are explored with management strategies and treatment options for both issues considered. As frontline practitioners during the puerperium, midwives are centrally placed to offer care and advice, emphasising the normality and self-limiting nature of GOR in the neonate and providing reassurance to parents. The importance of a meticulous feeding assessment and holistic midwifery approach to neonatal and maternal wellbeing is also examined. In light of the recently published national guidance, the care provision for babies experiencing GOR and GORD necessitates further midwifery consideration to ensure family-centred care.

Gastro-oesophageal reflux (GOR) is a commonly reported phenomenon encountered in the initial weeks of neonatal life, and is a normal physiological process which usually occurs following feeding (National Institute for Health and Care Excellence (NICE), 2015). However, GOR can cause distress and concern at an already challenging time during the transition to parenthood, often necessitating additional multidisciplinary support. It is a common condition, which only becomes problematic if symptoms are extreme enough to warrant treatment. Midwives may be the first practitioners with whom parents discuss feeding issues, and therefore are well-placed to counsel parents about the normality of GOR and when the condition becomes pathological GORD (gastro-oesophageal reflux disease) requiring intervention or treatment. Therefore, it is imperative that midwives can sensitively and knowledgeably interpret parents' communications about their babies' feeding habits to offer either minimal midwifery-based or multidisciplinary solutions once additional support is indicated.

To be able to provide appropriate reassurances to parents, it is important that all health professionals use clearly defined terminology. However, historically there has been great variation surrounding the definitions of GOR and GORD, with terms often being used interchangeably (NICE, 2015) (Figure 1). With disparity between professional classifications evident, it therefore becomes difficult to effectively communicate to parents, making the need for clarity all the more important.

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