Management of gastroesophageal reflux disease in pediatric patients with cerebral palsy.

Question As a family physician who provides care to a large pediatric population in the community, I see children with various neurologic impairments, many with cerebral palsy (CP), presenting with gastroesophageal reflux disease (GERD). What are the current recommendations to manage GERD in pediatric patients with CP?Answer A variety of lifestyle modifications can be used to manage GERD in pediatric patients with CP, including raising the head of the patient's bed, reducing patient weight, limiting exposure to smoke, and avoiding caffeine, spicy foods, fatty foods, and chocolate. The primary pharmacologic treatments currently recommended are histamine-2 receptor antagonists and proton pump inhibitors. Surgical treatments for GERD, like the Nissen fundoplication, might result in complications, so there is ongoing research looking at the benefits of using high-pectin diets, baclofen, and prokinetic agents like mosapride instead.