Gastro-oesophageal reflux (GOR) is the passage of gastric contents into the oesophagus. It is considered physiological in infants when symptoms are absent or not troublesome.

Gastro-oesophageal reflux disease (GORD) in children is the presence of troublesome symptoms or complications arising from GOR.

GOR occurs as a result of transient lower oesophageal sphincter (LES) muscle relaxation. Several anatomical and physiological features (such as delayed gastric emptying and short, narrow oesophagus) make infants (younger than one year old) more prone to GOR than older children and adults. GOR and GORD may also be caused by cow’s milk protein allergy. 5

Most children have no specific risk factors for GORD. However, children with certain conditions (such as cystic fibrosis, severe neurological impairment, and gastro-oesophageal abnormalities) are at an increased risk of developing GORD.

Complications that may occur in children with GORD include anaemia, chronic cough, and wheezing. GORD improves with age and can usually be diagnosed clinically. GORD should be suspected in children with either (but usually both) of the following:

  1. Frequent and troublesome regurgitation or vomiting (which may occur up to two hours after feeding).
  2. Frequent and troublesome crying, irritability, or back-arching during or after feeding, food refusal (despite being willing to suck on a dummy).

Children with GORD may also have oesophageal symptoms such as anaemia and dysphasia, respiratory symptoms such as asthma or reactive airways disease, and other symptoms such as sleeping difficulties and dental erosion.

4 National Institute for Health and Care Excellence, Gastro-oesophageal reflux disease: recognition, diagnosis and management in children and young people, 2014 Available at…/gord-in-children-guideline-consultation-draft-nice-gord-in-children-guideline-consultation-draft-nice-guideline2