Gastroesophageal reflux (GER)-related symptoms such as regurgitation, irritability, and crying are common in infancy and often overlap with normal developmental behaviors. The Infant Gastroesophageal Reflux Questionnaire Revised (I-GERQ-R) was developed to objectively assess these symptoms; however, previously proposed cut-off values did not account for age-related variation.
This study aimed to establish age-dependent normal values for the I-GERQ-R in healthy infants to support more accurate clinical interpretation.
Conceptual illustration of gastroesophageal reflux-related symptoms in relation to growth and scores.
Key Clinical Insights
In a cross-sectional survey of 979 healthy infants aged 0-24 months, the median I-GERQ-R score was 6, with scores decreasing significantly with age.
Overall, 5% of healthy infants had scores ≥16, a threshold previously considered suggestive of GER disease (GERD). Higher scores were most frequently observed in early infancy, up to 16% of newborns aged 0-1 month, and largely disappeared after 15-16 months. The elevated scores in younger infants were primarily driven by the high prevalence of regurgitation, colic-related symptoms, and hiccups, all of which declined over time.
Importantly, the authors emphasize that scores ≥16 should not automatically be considered pathological in young infants, highlighting the need for age-appropriate interpretation.
Age-Related Symptom Patterns in Healthy Infants
- Regurgitation occurred in 70-79% of infants during the first 6 months, with prevalence falling markedly thereafter.
- Crying symptoms decreased even faster, with over half of infants aged ≥4 months crying less than 10 minutes per day.
- Overall GER-related symptoms declined mainly during the first year of life, approaching near resolution in most infants after 12 months.
These findings reinforce the physiological nature of many reflux-like symptoms in early infancy.
Implications for Clinical Practice
This study provides practical guidance to help healthcare professionals:
- Interpret I-GERQ-R scores within an age-specific clinical context
- Recognize that reflux symptoms are frequently physiological and self-limiting
- Avoid over-diagnosis of GERD based solely on questionnaire thresholds
- Support the development of validated age-dependent diagnostic tools
Access the full publication: https://doi.org/10.1007/s00431-023-05281-w
Source
European Journal of Pediatrics, 2024
van Lennep M. et al.
DOI: 10.1007/s00431-023-05281-w