What dietary measures are recommended for 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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Answer

Thickening an infant’s formula provides a therapeutic advantage against gastroesophageal reflux, particularly when excessive vomiting is associated with suboptimal weight gain. Even for infants with normal weight gain, thickened and reduced volume feedings may reduce the frequency and amount of vomiting episodes, ameliorating the concerns of an anxious caregiver. [14] For formula-fed infants older than 3 months, thickening is typically achieved by the addition of 1 tablespoon of rice cereal per 2 oz of formula.

Younger formula-fed infants may benefit from a prethickened, proprietary formula (Enfamil-AR; Mead-Johnson Nutritionals Inc, Evansville, IN). For breast-fed infants, aside from increasing feeding frequency, expressed breast milk may be thickened as described. In addition, early introduction of rice cereal feedings (at age 3 mo) may be attempted. Research suggests that formula thickening is superior to positioning in promoting weight gain and reducing clinical symptoms in infants with gastroesophageal reflux. [1]

In children, small, frequent meals are also recommended. Greasy and spicy foods, which encourage postprandial reflux by increasing gastric distention and slowing gastric emptying, should be avoided. Chocolate, peppermint, tomato products, citrus, and caffeine, which lowers LES pressure, should also be avoided.


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