Mother with baby

Reflux and regurgitation

Managing the symptoms of reflux and regurgitation can be challenging. We’ve gathered the latest guidelines and expert opinions to support healthcare professionals to make the correct diagnosis and help to reduce concern among parents. Click on each of the tabs below to learn more about infant reflux and regurgitation and to download resources.

Reflux and regurgitation are considered normal physiological processes that occur several times a day in healthy infants. They are caused by the valve at the top of the stomach having a weak action allowing food and stomach acid to move back into the oesophagus.1 Regurgitation is the most common infant feeding problem affecting almost 1 in 3 infants.

Rome IV Diagnostic Criteria3

Must include both of the following, in otherwise healthy infants, 3 weeks to 12 months of age:
  • Regurgitation 2+ times per day for 3+ weeks
  • Without the presence of retching, hematemesis, aspiration, apnoea, failure to thrive, feeding or swallowing difficulties, or abnormal posturing

Research indicates that reflux reaches its peak around 4 months and begins to resolve by 7 months although some infants may have symptoms up to 12 months.1,3 Every infant will vary in this.

ESPGHAN Guidelines on Management4

EAACI Review of Pharmacological Management5

  • No guideline recommends the use of prokinetic agents
  • ESPGHAN4 found insufficient evidence to recommend a trial with an alginate
  • H2RAs do not reduce crying/distress or visible regurgitation/vomiting and have limited evidence on efficacy and safety
  • Concerns that PPIs impact the long-term bioavailability of certain vitamins/minerals and increase the risk of developing food allergy

  1. Vandenplas et al. J Pediatr Gastroenterol Nutr 2009; 49:498–547.
  2. Vandenplas et al. J Pediatr Gastroenterol Nutr 2015;61:531–7
  3. Benninga MA et al. Gastroenterology 2016; 150: 1443–1455.e2.
  4. Rosen R et al. J Pediatr Gastroenterol Nutr 2018; 66(3):516– 554
  5. Meyer R et al., Pediatr Allergy Immunol. 2022 Oct;33(10):e13856. doi: 10.1111/pai.13856. PMID: 36282131

ESPGHAN: European Society of Paediatric Gastroenterology Hepatology and Nutrition; GERD: Gastroesophageal Reflux Disease; GI: Gastrointestinal; EAACI: European Academy of Allergy & Clinical Immunology; H2RA: Histamine 2-Receptor Antagonists; PPI: Proton Pump Inhibitors

Breastfeeding is best for infants. Instant Carobel is a food for special medical purposes for the dietary management of habitual and recurrent vomiting, and rumination. It should only be used under medical supervision, after full consideration of the feeding options available including breastfeeding. Suitable for full term infants, children and adults. It is not suitable for use as the sole source of nutrition. For enteral use only.

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