Čes-slov Pediat 2026, 81(2):67-70 | DOI: 10.55095/CSPediatrie2026/008

Gastroesophageal reflux in infants

Jana Tomanová¹, Rita Halašová¹, Vanda Mečiarová², Jan Melek¹

¹ Dětská klinika, Fakultní nemocnice Hradec Králové, Lékařská fakulta v Hradci Králové, Univerzita Karlova

² Lékařská fakulta v Hradci Králové, Univerzita Karlova

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 de velop 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.

Keywords: Choosing Wisely, gastroesophageal reflux, infants, proton pump inhibitors, European Academy of Paediatrics

Accepted: February 5, 2026; Published: March 1, 2026  Show citation