Infant Feeding Difficulties Clinic (IFDC) & Paediatric Infant Feeding Allergy Clinic (IFAC) (Paediatric Guidelines)

For symptoms suggestive of reflux:

• Back arching/pulling up legs/extreme discomfort
• Extreme crying for >3-4 hrs/day for at least a week
• Oral aversion: refusing feeds or taking small amount
• Poor sleep (i.e. difficult to settle, not keen to lay on back, crying out in pain)
• Regurgitation & at least one of the above symptoms
• Coughing/hiccupping/wheezing/hoarse

First line advice: to follow prior to referral:

1. Breast fed: ensure a full breastfeeding assessment is carried out by an appropriately trained Health Care Professional , ensuring positioning and attachment has been assessed as effective
2. Formula fed: ensure feeding is responsive: feed to around 150ml/kg/day (1oz = 28ml) & try small frequent feeds
3. Assess for tongue tie: If suspected, refer to: nhsh.specialistbreastfeedingclinic@nhs.scot 
   If no improvement:
4. Breast Fed: Start a two week trial of GavisconInfant or Cow & Gate Instant Carobel. For Carobel give as a paste before feeding 3 scoops to 2oz EBM 
   Formula Fed: Start a two week trial of Carobel as follows:
   Start at:  ½ scoop of carobel for every 90mls/3oz of feed. If there is no improvement, then increase to 1 scoop – 1 ½ scoops per 90ml/3oz of feed. See separate information sheet on carobel.
   If no improvement to symptoms:
5. Refer immediately to IFDC. Consider commence dispersible omeprazole at 1mg/kg once daily (with minimum dose of 5mg). It is good practice to provide omeprazole advice sheet Medicines for children