Gastro-oesophageal Reflux Disease in Children

What this deck covers

Gastro-oesophageal Reflux Disease in 18 board-style clinical cases with worked explanations. Each case gives you a clinical vignette, four options, the correct answer, and an explanation of why each of the other three is wrong, with the guideline or textbook it follows named on the answer.

Board-style teaching questions for paediatricians and trainees preparing for board, MRCPCH and Prometric examinations. Written from published guidelines and standard paediatric textbooks, with the source named on every answer.

The 18 cases, in order

1. Sick after every feed, thriving
2. The vomit turned green
3. Stiffening spells after a feed
4. Sick, bloody stool, itchy cheeks
5. Big bottles, laid flat
6. Chest infections in cerebral palsy
7. Burning chest, worse lying down
8. Food that sticks after treatment
9. Blue spells after feeds, preterm
10. Treated, still falling through centiles
11. Slow eating after atresia repair
12. Aspiration despite maximal treatment
13. Forceful vomiting, still hungry
14. Five months of treatment, well baby
15. Retching but nothing comes
16. Night cough and morning hoarseness
17. A year of vomiting, thriving
18. Vomiting with a full fontanelle

Diagnoses and management options tested

Across the 18 cases you are asked to choose between options such as: Arrange an upper gastrointestinal contrast study, Abdominal ultrasound to measure the pyloric muscle, Focal seizures arising from the temporal lobe, Start an alginate preparation with each feed, Domperidone to speed gastric emptying, Aspiration related to reflux and an unsafe swallow, Reassure and review again in three months, Start a proton pump inhibitor and observe the effect, Continue the current plan for a further six weeks, A recurrent tracheo-oesophageal fistula, Increase the proton pump inhibitor to twice daily, Cow’s milk protein allergy, Substitute a histamine receptor antagonist instead, An episode of severe reflux oesophagitis.

Clinical pearls from this deck

• Ask whether the baby is happy and growing. That answer decides everything else.
• Green vomiting in a baby is a surgeon’s problem until a study says otherwise.
• Posturing that follows feeds and spares awareness is oesophageal, not cerebral.
• Reflux plus blood plus eczema is not reflux. Take the dairy out of the mother.
• Fix the feed volume and the posture before you reach for a prescription.
• In severe neurodisability the lungs often announce the reflux before the stomach does.

Work through the deck once for recognition, then again a week later to test yourself — each question gives the answer and explains why every other option fails.

More from this system: all Gastroenterology Board Questions case decks · pediatric reference values.