Choosing Wisely:

Avoid using acid blockers and motility agents such as metoclopramide (generic) for physiologic gastroesophageal reflux that is effortless, painless, and not affecting growth. Do not use medication in the so-called “happy-spitter.”

Rationale and Comments: There is scant evidence that gastroesophageal reflux is a causative agent in many conditions though reflux may be a common association. There is accumulating evidence that acid-blocking and motility agents such as metoclopramide (generic) are not effective in physiologic gastroesophageal reflux. Long-term sequelae of infant gastroesophageal reflux is rare, and there is little evidence that acid blockade reduces these sequelae. The routine performance of upper gastrointestinal tract radiographic imaging to diagnose gastroesophageal reflux or GERD is not justified. Parents should be counseled that gastroesophageal reflux is normal in infants and not associated with anything but stained clothes. Gastroesophageal reflux that is associated with poor growth or significant respiratory symptoms should be further evaluated.
Sponsoring Organizations:
  • American Academy of Pediatrics
  • Sources:
  • Expert consensus
  • Disciplines:
  • Pediatric
  • Gastroenterologic
  • References: • Lightdale JR, Gremse DA; American Academy of Pediatrics Section on Gastroenterology, Hepatology, and Nutrition. Gastroesophageal reflux: management guidance for the pediatrician. Pediatrics. 2013 May;131(5):e1684–95.

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