How to manage infants with regurgitation
Is the infant breastfed?
Yes
No
How to manage infants with regurgitation
Recommendation
Continue breastfeeding (reassurance, frequency, volume, technique)
Cows' milk free diet if CMPA is suspected
How to manage infants with regurgitation
Is the age of onset more than 1 week or less than 6 months?
Yes
No
How to manage infants with regurgitation
Check frequency/volume/technique and correct if required.
Is there improvement?
Yes
No
How to manage infants with regurgitation
Are there 4 episodes or more, daily for 1 week or more?
Yes
No
How to manage infants with regurgitation
Are there alarm signs or symptoms?
Yes
No
How to manage infants with regurgitation
Is there failure to thrive; hematemesis; back arching/Sandifer; neurological abnormalities; or neurodevelopmental delay?
Yes
No
How to manage infants with regurgitation
Recommendation
Refer to specialist
How to manage infants with regurgitation
Recommendation
Follow-up
How to manage infants with regurgitation
Recommendation
Refer patient to speciality consultation
Consider GERD, eosinophilic esophagitis, anatomical anomalies
How to manage infants with regurgitation
Is there vomiting, irritability/crying, fussiness, feeding problems, atopic dermatitis, eczema, constipation, diarrhea, sleeping problems or elevated CoMISS*?
Yes
No
How to manage infants with regurgitation
Recommendation
Reassure parents
Anti-regurgitation formula
Positional treatment
Is there improvement?
Yes
No
How to manage infants with regurgitation
Recommendation
Consider CMPA
eHF(thickened) 2-4 weeks in FF
Is there improvement?
Yes
No
How to manage infants with regurgitation
Recommendation
Challenge and follow-up according to CMPA