Quality statement 4: Alginate therapy

Quality statement

Infants with frequent regurgitation associated with marked distress have a trial of alginate therapy if first‑line management is unsuccessful.

Rationale

By reacting with acidic gastric contents, the alginate forms a viscous gel that stabilises stomach activity, which can be effective in reducing gastro‑oesophageal reflux (GOR) in some infants. Alginate therapy should only be tried if first-line management (feeding assessment and advice for breast‑fed infants or a stepped‑care approach for formula‑fed infants) is unsuccessful. In formula‑fed infants, thickened formula should be stopped before alginate therapy is offered.

Quality measures

Structure

Evidence of local arrangements to ensure that infants with frequent regurgitation associated with marked distress have a trial of alginate therapy if first‑line management is unsuccessful.

Data source: Local data collection.

Process

a) Proportion of breast‑fed infants with frequent regurgitation associated with marked distress that continues despite a feeding assessment and advice who have a trial of alginate therapy.

Numerator – number in the denominator who have a trial of alginate therapy.

Denominator – number of breast‑fed infants presenting with frequent regurgitation associated with marked distress that continues despite a feeding assessment and advice.

Data source: Local data collection.

b) Proportion of formula‑fed infants with frequent regurgitation associated with marked distress that continues despite a feeding assessment and advice who have a trial of alginate therapy.

Numerator – number in the denominator who have a trial of alginate therapy.

Denominator – number of formula‑fed infants with frequent regurgitation associated with marked distress that continues despite a stepped‑care approach.

Data source: Local data collection.

Outcome

Infants with frequent regurgitation associated with marked distress presenting in healthcare settings.

Data source: Local data collection.

What the quality statement means for different audiences

Service providers (community care providers, secondary care and specialised women's trusts) ensure that healthcare professionals offer a trial of alginate therapy for infants with frequent regurgitation associated with marked distress if first-line management is unsuccessful.

Healthcare professionals (health visitors, midwives, paediatric nurses or GPs) offer a trial of alginate therapy for infants with frequent regurgitation associated with marked distress if first‑line management is unsuccessful.

Commissioners (clinical commissioning groups, local authorities, NHS England) ensure that the services they commission offer a trial of alginate therapy for infants with frequent regurgitation associated with marked distress if first-line management is unsuccessful.

Parents and carers who have had support and advice about correct breastfeeding techniques (for breast‑fed babies) or tried using smaller and more frequent feeds followed by thickened formula (for formula‑fed babies), but whose baby's symptoms haven't improved are offered a medicine called an alginate for a trial period of 1 to 2 weeks. Alginates may help to reduce reflux.

Source guidance

Gastro-oesophageal reflux disease in children and young people (2015) NICE guideline NG1, recommendations 1.2.3, 1.2.4 and 1.2.5 (key priority for implementation)

Definitions of terms used in this quality statement

Trial of alginate therapy

By reacting with acidic gastric contents the alginate forms a viscous gel that stabilises stomach activity which results in reducing the incidence of GOR.

Infants have alginate therapy for a period of 1–2 weeks to assess if GOR improves. After the trial period, the approach needs to be reviewed by the healthcare professional.

[Gastro-oesophageal reflux disease in children and young people (2015) NICE full guideline NG1 and expert opinion]

First-line management

In breast‑fed infants with frequent regurgitation associated with marked distress, first‑line management is a breastfeeding assessment carried out by a person with appropriate expertise and training.

In formula‑fed infants with frequent regurgitation associated with marked distress, first‑line management is a stepped-care approach, as follows:

  • review the feeding history, then

  • reduce the feed volumes only if excessive for the infant's weight, then

  • offer a trial of smaller, more frequent feeds (while maintaining an appropriate total daily amount of milk) unless the feeds are already small and frequent, then

  • offer a trial of thickened formula (for example, containing rice starch, cornstarch, locust bean gum or carob bean gum).

In formula‑fed infants, if the stepped‑care approach is unsuccessful stop the thickened formula and offer alginate therapy for a trial period of 1–2 weeks.

[Adapted from gastro-oesophageal reflux disease in children and young people (2015) NICE guideline NG1, recommendations 1.2.2, 1.2.3 and 1.2.5 (key priority for implementation)].