New advice on treating gastro-oesophageal reflux disease

Clinical   kit pic

The National Institute for Health and Care Excellence (NICE) has issued new advice to healthcare professionals to be alert to red flag symptoms, which may suggest gastro-oesophageal reflux disease (GORD) or other disorders.

Bringing up food is a common physiological process that usually happens after eating in healthy infants, children, and young people and does not require treatment.

However, GORD is so severe that medical treatment is required and NICE recommends that health professionals look for ‘red flag’ symptoms which may need further investigation or referral.

Symptoms and signs

Possible diagnostic implications

Suggested actions

Frequent, forceful (projectile) vomiting

May suggest hypertrophic pyloric stenosis in infants up to two months old 

Urgent transportation to hospital

Abdominal distension, tenderness or palpable mass

May suggest intestinal obstruction or another acute surgical condition 

Urgent transportation to hospital

Chronic diarrhoea

May suggest cow’s milk protein allergy (also see the NICE guideline on food allergy in children and young people)

Specialist referral / transport to hospital

Bulging fontanelle

May suggest raised intracranial pressure, for example, due to meningitis (also see the NICE guideline on bacterial meningitis and   meningococcal septicaemia)

Specialist referral / transport to hospital

Rapidly increasing head circumference (more than 1cm per week)

Persistent morning headache, and vomiting worse in the morning

May suggest raised intracranial pressure, for example, due to   hydrocephalus or a brain tumour

Specialist referral / transport to hospital – consider pre-alert if symptoms are severe enough.


Routine investigation or treatment for GORD is unnecessary if a child or infant doesn’t have overt regurgitation and only presents with one of the following:

  • unexplained feeding difficulties (for example, refusing to feed, gagging or choking)
  • distressed behaviour
  • faltering growth
  • chronic cough
  • hoarseness
  • a single episode of pneumonia.

For more information or to read the full guidance, please visit the NICE website.

Published 14th February 2015

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