Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Obstruction, bleeding or systemic illness
Bilious vomiting, haematemesis with instability, abdominal distension, shock, sepsis features or acute neurological abnormality is not uncomplicated reflux.
Action: Stabilise airway, breathing and circulation, check glucose and hydration, stop oral feeds if obstruction is suspected, obtain urgent paediatric or surgical assessment and investigate according to the presentation. Projectile vomiting in a young infant needs same-day evaluation for pyloric stenosis; significant dehydration or electrolyte disturbance needs controlled correction.
Synopsis
Recognise physiological regurgitation, identify reflux disease and alternative pathology, avoid unnecessary tests and acid suppression, use feed assessment and stepwise management, and give families safe sleep and escalation advice.
Gastro-oesophageal reflux is passage of gastric contents into the oesophagus and is common in infancy. In a thriving comfortable baby, visible regurgitation is usually physiological and resolves by 12–18 months.
Diagnose uncomplicated reflux clinically. Do not routinely investigate a well infant with effortless regurgitation, normal examination and satisfactory growth.
First-line for a breastfed infant with frequent regurgitation and marked distress is a skilled breastfeeding assessment addressing transfer, oversupply, positioning and attachment while continuing breastfeeding.
Key red flags
Bilious green vomit indicates possible intestinal obstruction and requires urgent surgical assessment.
Investigation priorities
01
First-line: clinical and feeding assessmentFirst stepFirst line
Distinguish physiological reflux, disease and red-flag mimics.
Management branches
WellReassure and support
Regurgitation is effortless, growth and examination are normal and no red flag is present.
Explain natural resolution and continue responsive milk feeding.
Observe technique and avoid excessive volumes while maintaining nutritional needs.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.