Gastro-oesophageal Reflux in Neonates, Infants and Children

Does positioning have an effect on GOR? A systematic review of randomised controlled trials (Carroll, 2002) quotes a controlled prospective study of 9 infants with GOR (Orenstein, 1983) which found that positioning at a 60 degree elevation in an infant seat increased reflux compared with the prone position. A later study by the same author (Orenstein, 1990) found no significant difference between the flat and head-elevated prone positions. The “supine reversed-Trendelenburg sleeping position”, recommended by some (Taminiau, 1997), was found to increase acid reflux parameters in all 10 consecutively investigated infants in a Belgian study (Bagucka, 1999). A study of 18 preterm infants with GOR (Ewer, 1999) compared prone, left lateral and right lateral positions. Each position was used for 8 hours, with the order randomly assigned. The reflux index was significantly less in prone (6.3) and left lateral (11.0) positions compared to the right lateral (29.4). The left lateral position may be an acceptable alternative, in infants, to the prone position which has been associated with sudden infant death (Tobin, 1997; Vandenplas, 1997) and is recommended in US guidelines (Anon, 2001) for children older than one year. The effects of positioning have not been studied in children older than 1 year (Anon, 2001). A study in 22 premature infants (Corvaglia, 2007) found that oesophageal exposure to acid and nonacid GOR was lower in the prone (4.4% and 0.3%, respectively) and the left lateral (7.5% and 0.7%, respectively) positions than in the right lateral (21.4% and 1.2% respectively) and supine (17.6% and 1.3%, respectively) positions.