Authors: Jana Tomanová 1; Rita Halašová 1; Vanda Mečiarová 2; Jan Melek 1 Authors‘ workplace: Dětská klinika, Fakultní nemocnice Hradec Králové, Lékařská fakulta v Hradci Králové, Univerzita Karlova 1; Lékařská fakulta v Hradci Králové, Univerzita Karlova 2 Published in: Čes-slov Pediat 2026; 81 (2): 67-70. Category: Choosing Wisely doi: https://doi.org/10.55095/CSPediatrie2026/008
Tomanová J, Halašová R, Mečiarová V, Melek J. Gastroesophageal reflux in infants
Gastroesophageal reflux (GER) in infants is, in the majority of cases, a physiological phenomenon that resolves spontaneously. The cornerstone of diagnosis is a careful medical history and physical examination, with particular attention to excluding alarm signs that may indicate gastroesophageal reflux disease (GERD) or another underlying condition. The vast majority of infants without alarm features thrive well and do not develop respiratory or neurological complications. The mainstay of management consists of parental education combined with conservative measures (avoiding overfeeding, continuing breastfeeding, and thickening feeds). If these measures are insufficiently effective, an extensively hydrolyzed formula or, if appropriate, an amino acid–based formula may be used for 2–4 weeks, considering the possible presence of cow’s milk protein allergy. Proton pump inhibitors (PPIs) are being prescribed with increasing frequency in the pediatric population, and their use as part of “reflux treatment” in infants is rising. However, current evidence does not demonstrate the effectiveness of PPIs in reducing nonspecific symptoms such as irritability or crying, while the risk of adverse effects is significant. In infants treated with PPIs, an increased risk of dysbiosis, gastrointestinal and respiratory infections, impaired mineral absorption, disruption of bone metabolism, and a higher incidence of allergic diseases has been reported. Therefore, expert recommendations emphasize that PPIs should be indicated only for clearly defined conditions, particularly erosive esophagitis and objectively confirmed GERD. Initiation of this therapy should always be preceded by a comprehensive evaluation of the infant by a specialist. The use of prokinetic agents in infants with GER or GERD is not routinely recommended.
gastroesophageal reflux – Infants – proton pump inhibitors – Choosing wisely – European Academy of Paediatrics
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