Stepped-care approach for infant reflux

Morgan Liotta

6/03/2020 4:13:27 PM

In the third of a series of HANDI updates, newsGP talks to the author of a recently added intervention.

Breastfeeding baby
The new HANDI intervention details a stepped-care approach for effective non-drug treatment for babies experiencing reflux.

The RACGP’s Handbook of Non-Drug Interventions (HANDI) aims to provide GPs with free, up-to-date evidence-based interventions that do not rely on prescribing medicine. HANDI also offers resources to assist in patient decision-making.
Recent updates and new HANDI entries add to the suite of 65 interventions, with more in development and planned to be released on the site over the coming year.

Dr Ben Ewald, lead author of the newly added intervention, ‘Feed thickener for infant reflux’, told newsGP he finds HANDI to be an important resource.
‘HANDI collects, assesses and publicises treatments for which there is good evidence of effectiveness,’ he said.
‘It also has a useful collection of patient handouts and training materials where these are relevant. [For example,] I go to the HANDI website and print out the instructions for every patient with plantar fasciitis.
‘It’s great for those conditions we don’t see every day, and need to look up the fine details of the non-drug treatments.’
According to HANDI, a small amount of reflux or regurgitation is very common in small babies and does not need treatment. However, more serious reflux can cause pain, poor growth, or oesophageal ulceration, which may present as irritability, recurrent vomiting, or refusal to feed.
The best approach to infant reflux is a stepped-care approach as described in the HANDI entry, according to Dr Ewald.
‘Try smaller more frequent feeds,’ he explained.
‘For bottle-fed babies, try a cereal-based thickener. For bottle or breastfed babies, try an alginate thickener.’
Alginate thickener should be trialled for 1–2 weeks and only continued if effective, HANDI advises, and as research shows it can be effective and is safe, parents or carers will be able to rapidly report if it works for their baby.
Dr Ewald said the parents or carers of a baby experiencing reflux will know best when a treatment is effective, ie if the pain is reduced.
‘Once a parent has found something that works, try stopping it every four weeks to see if the problem has resolved.’
He also highlighted this advice is only for full-term (> 38 weeks) babies, as adverse effects of feed thickener have only been seen in premature babies.
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HANDI infant health non-drug interventions

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