The relation between gastro-oesophageal reflux, sleeping-position and sudden infant death and its impact on positional therapy.
Many infants do regurgitate. The recommended therapeutic approach starts with postural and dietary measures, followed by antacids and prokinetics. However, the recent findings regarding the increased risk for sudden infant death (SID) in the prone sleeping position challenge the current recommendations. Management of regurgitation should in the first place aim at reducing parental anxiety. Postural treatment favouring the prone-elevated (30 degrees) position is no longer recommended as a first line treatment of regurgitation, despite its efficacy, because of the unexplained association of SID with the flat prone sleeping position. Favouring the prone elevated position would result in an increased parental anxiousness.


CONCLUSIONS
Positional treatment can only be recommended in children beyond the age of SID risk, or as an adjuvant therapy in cases resistant to reassurance, thickeners and prokinetics and in whom other diagnostic possibilities (infection, etc.) are considered rejected.
Vandenplas
Y
Y
AZK-VUB, Brussels, Belgium.
Belli
D C
DC
Dupont
C
C
Kneepkens
C M
CM
Heymans
H S
HS
D005764:Gastroesophageal Reflux / Q000628:therapy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016684:Prone Position; D012307:Risk Factors; D012890:Sleep; D013398:Sudden Infant Death / Q000453:epidemiology