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