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NICE stepwise recommendations on infant regurgitation

This article outlines NICE recommendations for managing infant reflux and regurgitation and provides links to useful information.

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Functional gastrointestinal issues are common in infancy1. For example, around 30% of infants below one year of age will experience regurgitation1. This can be a distressing and confusing time for parents, who may not be confident in what to change or adapt to help their baby keep down their feed.

For first-line management of breast-fed infants who present with frequent regurgitation and marked distress, NICE recommends a breastfeeding assessment is carried out by a person with appropriate expertise or training.

For formula-fed infants NICE have developed a stepped-care approach2:

  1. Review the feeding history
  2. Reduce the feed volumes only if excessive for the infant’s weight
  3. Offer a trial of smaller, more frequent feeds – while maintaining the advised daily intake of milk (unless the feeds are already small and frequent)
  4. Offer a trial of a thickened formula (that contains rich starch, cornstarch, locust bean gum or carob bean gum)

  1. Vandenplas Y et al. Prevalence and Health Outcomes of Functional Gastrointestinal Symptoms in Infants From Birth to 12 Months of Age. J Pediatr Gastroenterol Nutr 2015;61(5):531-537.
  2. Nice. Gastro-Oesophageal Reflux Disease: Recognition, Diagnosis and Management in Children and Young People. January 2015. Available At: www.nice.org.uk/guidance/ng1 (Accessed April 2016).

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