Introduction

This quality standard covers managing symptoms of gastro‑oesophageal reflux (GOR) and recognising, diagnosing and managing gastro‑oesophageal reflux disease (GORD) in children and young people under 18. It does not cover dyspepsia and GORD in adults. This is covered in NICE quality standard 96 (Dyspepsia and gastro-oesophageal reflux disease in adults: investigation and management [2015]). For more information see the topic overview.

Why this quality standard is needed

GOR is a normal physiological process that usually happens after eating in healthy infants, children, young people and adults. In contrast, GORD starts when symptoms of reflux become severe and need medical treatment. GOR is more common in infants than in older children and young people, and presents as effortless regurgitation of feeds.

GOR and GORD affect many children and families in the UK, who commonly seek medical advice. In clinical practice, it may be difficult to differentiate between GOR and GORD, and both terms are used by healthcare professionals and families. There is no simple, reliable and accurate diagnostic test to confirm whether the condition is GOR or GORD, and this affects research and clinical decisions. Furthermore, the term GORD covers a number of specific conditions that have different effects and present in different ways. This makes it difficult to identify GORD and to estimate its real prevalence.

The quality standard is expected to contribute to improvements in the following outcomes:

  • Health‑related quality of life.

  • Change in symptoms and signs, for example:

    • volume or frequency of regurgitation

    • crying and distress

    • nutritional status.

  • Investigative findings, including healing of erosive oesophagitis.

  • Adverse events of interventions (diagnostic or treatment).

  • Unnecessary prescribing.

How this quality standard supports delivery of outcome frameworks

NICE quality standards are a concise set of prioritised statements designed to drive measurable improvements in the 3 dimensions of quality – patient safety, patient experience and clinical effectiveness – for a particular area of health or care. They are derived from high‑quality guidance, such as that from NICE or other sources accredited by NICE. This quality standard, in conjunction with the guidance on which it is based, should contribute to the improvements outlined in the following 2 outcomes frameworks published by the Department of Health:

Tables 1 and 2 show the outcomes, overarching indicators and improvement areas from the frameworks that the quality standard could contribute to achieving.

Table 1 NHS Outcomes Framework 2015–16

Domain

Overarching indicators and improvement areas

2 Enhancing quality of life for people with long‑term conditions

Improvement areas

Reducing time spent in hospital by people with long‑term conditions

Ensuring people feel supported to manage their condition

2.1 Proportion of people feeling supported to manage their condition

2.3i Unplanned hospitalisation for chronic ambulatory care sensitive conditions

3 Helping people to recover from episodes of ill health or following injury

Improvement areas

3.1i Total health gain as assessed by patients for elective procedures

Table 2 Public health outcomes framework for England, 2013–16

Domain

Objectives and indicators

2 Health improvement

Objective

People are helped to live healthy lifestyles, make healthy choices and reduce health inequalities

Indicators

2.2 Breastfeeding

2.5 Child development at 2–2½ years

4 Healthcare public health and preventing premature mortality

Objective

Reduced numbers of people living with preventable ill health and people dying prematurely, whilst reducing the gap between communities

Indicators

4.2 Tooth decay in children aged 5

Coordinated services

The quality standard for GORD in children and young people specifies that services should be commissioned from and coordinated across all relevant agencies encompassing the whole care pathway for children and young people with reflux and GORD. A person‑centred, integrated approach to providing services is fundamental to delivering high‑quality care to children and young people with reflux and GORD.

The Health and Social Care Act 2012 sets out a clear expectation that the care system should consider NICE quality standards in planning and delivering services, as part of a general duty to secure continuous improvement in quality. Commissioners and providers of health and social care should refer to the library of NICE quality standards when designing high‑quality services. Other quality standards that should also be considered when choosing, commissioning or providing a high‑quality reflux and GORD service are listed in related quality standards.

Training and competencies

The quality standard should be read in the context of national and local guidelines on training and competencies. All health and public health practitioners involved in assessing, caring for and treating children and young people with GOR and GORD should have sufficient and appropriate training and competencies to deliver the actions and interventions described in the quality standard. Quality statements on staff training and competency are not usually included in quality standards. However, recommendations in the development source on specific types of training for the topic that exceed standard professional training are considered during quality statement development.

Role of families and carers

Quality standards recognise the important role families and carers have in supporting children and young people with GOR and GORD. Quality standards also recognise the anxiety parents and carers feel when children and young people experience the symptoms. Healthcare professionals should ensure that parents and carers are reassured and, when appropriate, involved in the decision‑making process on ways to improve the symptoms of GOR and GORD.