š©ŗ Clinical Summary
- ā Key Finding: Reflux-related symptoms and I-GERQ-R scores decrease with age in healthy infants.
- ā Evidence: In 979 healthy infants aged 0-24 months, the median I-GERQ-R score was 6, with scores declining significantly as age increased.
- ā Practice Tip: Interpret infant reflux score results within an age-specific clinical context; a score ā„16 should not automatically indicate GERD in young infants.
Gastroesophageal reflux in infants is common and often overlaps with normal developmental behaviors. Symptoms such as infant regurgitation, crying, irritability and feeding-related discomfort may raise concern for GERD symptoms in infants, but these features are also frequently reported in otherwise healthy infants.
The Infant Gastroesophageal Reflux Questionnaire Revised (I-GERQ-R) is used in infant reflux assessment to score reflux-related symptoms, including regurgitation, irritability and crying. However, previously suggested cut-off values, including an I-GERQ-R score of ā„16, did not account for reflux symptoms by age.
This study aimed to establish age-dependent normal values for the I-GERQ-R in healthy infants aged 0-24 months, to support more accurate clinical interpretation of reflux-related symptoms.
Conceptual illustration of gastroesophageal reflux-related symptoms in relation to growth and scores.
Key Clinical Insights on I-GERQ-R Score
This cross-sectional study included 979 healthy infants. The median I-GERQ-R score was 6, and scores decreased significantly with age, supporting the concept that reflux symptoms follow a clear age-related pattern.
Overall, 5% of healthy infants had an I-GERQ-R score ā„16, a threshold previously considered suggestive of GERD. Higher scores were most frequently observed in early infancy, reaching 16% in infants aged 0-1 month, and largely disappeared after 15-16 months of age.
The elevated scores in younger infants were mainly driven by the high prevalence of infant regurgitation, colic-associated symptoms and hiccups, all of which declined over time.
Reflux Symptoms by Age in Healthy Infants
Age-related symptom patterns were mainly driven by changes in regurgitation, crying-related symptoms and hiccup frequency.
Infant regurgitation was highly prevalent during the first months of life, occurring in 70-79% of infants during the first 6 months, before declining markedly thereafter. Crying symptoms decreased earlier than regurgitation, with more than half of infants aged 4 months and older reported to cry for less than 10 minutes per day.
Overall, reflux-like symptoms declined mainly during the first year of life and approached near resolution in most infants after 12 months. These findings reinforce the physiological and self-limiting nature of many reflux-like symptoms in early infancy.
GER vs GERD in Infants: Clinical Interpretation of Reflux Scores
The findings highlight the importance of distinguishing physiological reflux in infants from gastroesophageal reflux disease. A higher infant reflux score may reflect normal age-related symptoms rather than disease, particularly in the first months of life.
Importantly, the authors emphasize that age-dependent normal values should not be interpreted as diagnostic cut-off values. Further validation is needed before the I-GERQ-R can be used as a diagnostic tool to distinguish GER vs GERD in infants.
These results support a cautious interpretation of reflux questionnaires in clinical practice. Pediatric GERD diagnosis should not rely on questionnaire scores alone, especially when symptoms are common, mild and age-appropriate.
Implications for Pediatric GERD Diagnosis
This study provides practical guidance for healthcare professionals involved in infant reflux assessment.
In clinical practice, healthcare professionals should:
- Recognize that infant regurgitation and reflux-like symptoms are frequently physiological
- Interpret I-GERQ-R score results according to infant age
- Distinguish physiological reflux in infants from clinically significant GERD
- Use reflux questionnaires as supportive tools, not stand-alone diagnostic instruments
- Consider broader clinical features, including symptom severity, feeding difficulties, growth concerns and red flags
Overall, these findings support an age-sensitive approach to infant reflux assessment. Age-dependent reflux questionnaire scores in infants may help reduce overinterpretation of GERD symptoms in infants and support more appropriate clinical decision-making.
Access the full publication:Ā https://doi.org/10.1007/s00431-023-05281-w
Source
European Journal of Pediatrics, 2024Ā
vanĀ LennepĀ M. et al.Ā
DOI: 10.1007/s00431-023-05281-w
