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

Back to March ’14 Newsletter

 

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.

 

NAME: DATE: AGE:
Feeding issues Feeding Observations
  • Displaying a fear of food, unwillingness to eat, extreme fussiness or unusual eating habits including restricted types of food
  • Behavioural issues around mealtimes including avoidance
  • Refusal to feed or only taking small amounts despite being hungry
  • Gag/splutter or have problems swallowing
  • Having difficulties with some textures or with mixed textures
  • Comfort feeding e.g. wanting to snack frequently, unhappy unless they have something available to eat
  • Needs water constantly
  • Asks for milk frequently
  • Puts hand in mouth/down throat and/or sucking on fingers/clothes
  • Child experiences food getting stuck part way down (or complaining of the sensation of it)
Sleeping issues Sleeping observations
  • Difficulty settling at night
  • Frequent night waking
  • Restless or easily disturbed sleep
  • Preferring to be upright/may object to lying down
  • Prefers to sleep on stomach or left hand side
Average number of hours slept in a 24 hour period:Average number of wakes per night:Average duration of awakenings:
Weight issues Notes
  • Inadequate weight gain
  • Weight loss
  • Excessive weight gain
  • Inconsistent weight gain
Take child’s record book if available
Other Typical Symptoms Notes
  • Irritability, excessive crying or screaming
  • Complaining of pain (sore tummy, sore neck)
  • Being clingy, extremely sensitive, easily upset, demanding
  • Vomiting, posseting or regurgitation and/or complaining of “yukky bits in mouth”
  • Recurrent hiccups
  • Congestion, ‘snuffling’, wheezing or appearing to have a cold
  • Bad or sour smelling breath
  • Hoarseness, change in voice
  • Gulping, gagging, spluttering or throat clearing
  • Frequent red, sore throat (not necessarily with infection)
  • Recurrent ear, throat, sinus or chest infections or croup
  • Drooling or excessive salivation
  • Unexplained behavioural issues
  • Asks for Panadol/Dymadon/Paracetamol/ Mylanta
What has your child said to you?If verbalising reflux related pain, how often?
NAME: DATE: AGE:
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:

  • Increase time between dinner/drinks and bed
  • Elevating the bed head to sleep
  • Smaller meals more often

 

 

Diet Modification:

  • Any dietary modifications you have tried

 

 

Other Concerns Notes
  • Bowel motions (e.g. diarrhoea, constipation, mucous, blood, unusual colour, offensive odour)
  • Skin rashes
  • Allergies or intolerances
  • Potential triggers for reflux flares e.g. illness, change of routine, stress, vaccinations, constipation, being overtired, types of food

 

Describe any potential triggers that may be relevant:
Medical therapies/ investigations: Notes
Other medical issues that may be relevant:
Medical recommendations Notes
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