This is a checklist of reflux symptoms in children over the age of two years. RISA also has a checklist for children under the age of two years, which can be found here. 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 display a fear of food 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.
Download the RISA-Checklist-for-doctors-child over two years word document.
Author: Christine Nash
Reviewed: Joanne Matthews, RISA President
Last reviewed: March 2014
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.
|Feeding issues||Feeding Observations|
|Sleeping issues||Sleeping observations|
||Average number of hours slept in a 24 hour period:Average number of wakes per night:Average duration of awakenings:|
||Take child’s record book if available|
|Other Typical Symptoms||Notes|
||What has your child said to you?If verbalising reflux related pain, how often?|
|Is there a history of gastro-oesophageal reflux in your family? Yes/NoDoes your child have a history of reflux as an infant?||Details:|
|In-home strategies you have tried||Notes|
|To minimise reflux:
|Describe any potential triggers that may be relevant:|
|Medical therapies/ investigations:||Notes|
|Other medical issues that may be relevant:|