This is a checklist of reflux symptoms in children under the age of two years. This checklist does not offer a medical diagnosis, but rather assists parents to record their concerns and provide a framework for a productive discussion with their medical professionals. Please keep in mind that all children are different and the listed symptoms may not be indicative of your own child’s symptoms. A child with gastro-oesophageal reflux will not necessarily display all of them (some symptoms can be contradictory eg some children will feed refuse while others will comfort feed or over-eat), and the number of signs exhibited does not indicate the severity of their ‘reflux’. There are other signs your child may display as well.

Highlight or circle the symptoms relevant to your child and record details and observations in the right hand column. Consider videoing or photographing your child’s symptoms. Often they happen at awkward hours and bubs is as happy as Larry when you hit the doctor’s surgery. And don’t undersell what’s happening to make it seem like you’re coping ok – even if you are. Tell it like it is. Warts and all.

Download the word or pdf documents here.

Name: Age: Date:

Feeding issues

  • Displaying a fear of food or unwillingness to eat
  • General distress or discomfort e.g. pulling away and arching their back, fighting or pulling off the breast or bottle, pushing the breast/bottle away, stiffening up, squirming
  • Crying/screaming during or after feeds
  • Refusal to feed or only taking small amounts despite being hungry
  • Feeding only when drowsy or asleep
  • Gag/splutter or have problems swallowing
  • Having difficulties with some textures
  • Comfort feeding e.g. wanting to feed or suck frequently, unhappy unless feeding, large number of wet nappies due to frequent feeding

Feeding observations

Average number of feeds per day:

Average quantity taken per feed (if measurable):

Average time spent feeding:

Behaviour relating to feed:

Sleeping issues

  • Catnapping during the day
  • Difficulty settling
  • Frequent night waking
  • Restless or easily disturbed sleep
  • Preferring to be upright/may object to lying down

Sleeping observations

Average number of hours slept in a 24 hour period:

Weight issues

  • Inadequate weight gain
  • Weight loss
  • Excessive weight gain
  • Inconsistent weight gain

Note: Take infant’s record book

Information on weight charts from the Australian Breastfeeding Organisation can be found here.

Other typical symptoms

  • Irritability, excessive crying or screaming
  • Appearing to be in pain
  • Being clingy, extremely sensitive, easily upset, demanding
  • Appearing to be colicky or windy
  • Vomiting, posseting or regurgitation
  • Recurrent hiccups
  • ‘Wet’ burp or hiccups
  • Congestion, ‘snuffling’ or appearing to have a cold
  • Bad or sour smelling breath
  • Hoarseness, change in voice, stopping babbling/talking
  • Gulping, gagging, spluttering
  • Difficulty swallowing
  • Respiratory problems e.g. choking, coughing, wheezing
  • Frequent red, sore throat (not necessarily with infection)
  • Recurrent ear, throat, sinus or chest infections or croup
  • Drooling or excessive salivation
  • Gagging themselves (e.g. sticking their hand/fist/fingers down their throat)
  • Behavioural issues

Symptom observations:

Times/hours of crying per day:

How often does baby do large vomits and/or possets?

Describe:

List number of ear, throat, sinus or chest infections or croup:

Is there a history of gastro-oesophageal reflux in your family? Yes/No

Describe:

In-home strategies you have tried:

To minimise reflux:

  • Keeping upright for 30 mins after feed
  • Feeding baby in more upright position
  • Dummy
  • Thickeners
  • Avoiding tight clothing

To calm a distressed baby:

  • Swaddling for sleep
  • White noise during sleep
  • Carrier that keeps baby upright
  • Infant swing
  • Natural/over-the-counter remedies

Diet Modification:

  • Change to mother’s diet if breastfeeding

Medical therapies you have tried

Describe:

Other concerns

  • Bowel motions (e.g. diarrhoea, constipation, mucous, blood, unusual colour, offensive odour)
  • Skin rashes
  • Posturing
  • Allergies or intolerances
  • Potential triggers for reflux flares e.g. crawling, teething, illness, recent vaccinations, constipation, being overtired or out of routine, response to particular foods

Medical recommendation:

(Try to note outcomes from your appointment while they’re fresh in your mind.)

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