Nonpharmacological Strategies
Infant
• Avoid overfeeding.
• Thickened formula (including rice-added formula).
• Positioning:
- Keep the infant upright for 30 to 45 minutes after meals.
- Prone positioning may be used if the infant is observed and awake.
Note: “However, because of the risk of sudden infant death syndrome, supine positioning is recommended for sleep. Although elevating the head of the bed by 30° is recommended in children, it is recommended not to use positional therapy to treat symptoms of GERD in sleeping infants.”2
- A trial of formula with extensively hydrolyzed protein or amino-acid–based formula
Note: “There is no evidence to support the use of extensively hydrolyzed formula or amino-acid–based formula for the treatment of GERD in infants and children who do not have CMPA; however, because symptoms of GERD and CMPA are identical, a trial of extensively hydrolyzed formula or amino-acid–based formula is indicated in patients who have not responded to conventional GERD therapies.”1
Child/Adolescent:
• Eat smaller, more frequent meals.
• Avoid eating or drinking 2 to 3 hours before bedtime.
• Elevate the head of the bed to 30° if having nocturnal symptoms.
• Sleep in the left lateral decubitus position.
• Limit or avoid foods and drinks that provoke symptoms including carbonated drinks; chocolate; caffeine; and fatty, spicy, and acidic foods.
• Avoid large meals before exercise.
• Lose weight if overweight.
Note: “Based on expert opinion, the working group suggests informing caregivers and children that excessive body weight is associated with an increased prevalence of GERD.”2
2 Rosen R, Vandenplas Y, Singendonk M, et al. Pediatric gastroesophageal reflux clinical practice guidelines: joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr. 2018;66(3):516–554. doi: 10.1097/MPG.0000000000001889