How is patient positioning used in the treatment of pediatric gastroesophageal reflux disease (GERD)?

Updated: Mar 14, 2019
  • Author: Steven M Schwarz, MD, FAAP, FACN, AGAF; Chief Editor: Carmen Cuffari, MD  more...
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Infants and children diagnosed with gastroesophageal reflux should avoid the seated or the supine position shortly after meals.

Prone positioning may be recommended for the patient, at least for the first postprandial hour. Sleeping in the prone position has been demonstrated to decrease the frequency of gastroesophageal reflux. However, the association of prone positioning with sudden infant death syndrome (SIDS) has brought its use into debate. Observations suggest that SIDS in the prone position is related to either suffocation or rebreathing of carbon dioxide and is associated with puffy bedding material.

Clearly, the use of the prone position during infancy must be based on a careful risk-to-benefit analysis. When it is advised, only very firm bedding material (no pillows) must be used. Bed elevations offer no added advantage to the prone position, and seated positions are not recommended.

Studies that monitored esophageal acid exposure after elevation of the head of the bed showed a decrease in reflux activity in adults. Placing blocks under the head of the bed or placing a foam wedge under the patient's mattress can accomplish this.

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