The answer

Although there is no accurate data available, reflux in infants up to the age of one year is remarkably common. There is a spectrum of severity, with regurgitation – part or all of the stomach contents moving up the oesophagus into the mouth, also known as posseting – at the mild ‘completely normal’ end, and gastro-oesophageal reflux disease (GORD) which features troublesome symptoms such as discomfort or complications such as oesophagitis, aspiration pneumonia and recurrent otitis media, at the other extreme.

The condition usually begins before the age of eight weeks, and 90 per cent of cases resolve before the child’s first birthday, which may provide a level of reassurance to Melanie. Given that the baby is distressed, a stepped-care approach is sensible, which is what the healthcare visitor and GP have been advising. Melanie is now at the stage of trying a thickened formula milk containing either rice starch, cornstarch, locust bean gum or carob bean gum.

If this is unsuccessful, Melanie will be advised to stop the thickened formula and offer alginate therapy for a trial period of one to two weeks. If the alginate therapy is successful, Melanie should continue with it, but try stopping it at intervals to see if the baby has recovered. If the alginate therapy does not work, Melanie should return to the GP who may prescribe a four week trial of a proton pump inhibitor or histamine-2 receptor antagonist.