Rome IV Diagnostic Criteria for Infant Regurgitation
Official Rome IV criteria for the diagnosis of infant regurgitation.
Use in infants 3 weeks to 12 months with regurgitation for at least 3 weeks.
Patients with any of the following alarm features should be evaluated clinically for other diagnoses:
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Excessive irritability.
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Onset <3 weeks, > 6 months or persistence >12 months of age.
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Retching and/or persistent forceful vomiting.
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Bilious or nocturnal vomiting.
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Hematemesis.
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Aspiration.
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Respiratory symptoms (wheezing, stridor, cough, hoarseness).
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Apnea.
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BRUE (Brief Resolved Unexplained Event).
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Weight loss or failure to thrive.
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Feeding or swallowing difficulties including food refusal.
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Abnormal neurologic exam, posturin or seizures
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Dystonic neck posturing (Sandifer syndrome).
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Chronic diarrhea or constipation.
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Rectal bleeding.
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Macro or Microcephaly.
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Bulging fontanelle.
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Hepatosplenomegaly.
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Abdominal tenderness or distension.
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Documented or suspected genetic/metabolic syndrome.
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Fever.
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Lethargy.
If diagnosis not met (negative):
Current symptoms are unlikely to be related to infant regurgitation. Consider further assessment as clinically indicated. Also, see pearls and pitfalls above.
If meets diagnosis (positive):
Likely diagnosis of infant regurgitation. Provide reassurance and consider conservative treatment recommendations.
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Treatment consists of reassurance and supportive care as infant regurgitation typically resolves spontaneously.
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Symptoms related to infant regurgitation can result in significant caregiver distress and providing reassurance and guidance are very important.
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Upright positioning after feeds, smaller and more frequent meals, using anti-reflux formulas or thickening of feeds, postprandial left-sided and prone positioning are conservative measures that can help decrease regurgitation in healthy infants, especially in case of poor weight gain. It should be emphasized, however, that infants should sleep in the supine position to minimize risk of sudden infant death syndrome.
This calculator should only be used in infants who do not have signs or symptoms suggestive of a structural, mechanical, metabolic, infectious, neurologic or systemic cause of their symptoms based on a detailed clinical history, physical exam, and initial work-up.