Quality standard

Quality statement 5: Symptoms that do not need investigation or treatment

Quality statement 5: Symptoms that do not need investigation or treatment

Quality statement

Infants and children are not investigated or treated for gastro‑oesophageal reflux disease (GORD) if they have no visible regurgitation and only 1 associated symptom.

Rationale

Although a combination of symptoms, such as unexplained feeding difficulties (for example, refusing to feed, gagging or choking), distressed behaviour, faltering growth, chronic cough, hoarseness or a single episode of pneumonia can be associated with GORD, having no visible regurgitation and only 1 of these symptoms does not indicate GORD. Unnecessary investigations cause distress for infants and children, as well as costs to the NHS that can be avoided.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Structure

Evidence of local arrangements to ensure that infants and children are not investigated or treated for GORD if they have no visible regurgitation and only 1 associated symptom.

Data source: Local data collection.

Process

Proportion of infants and children with no visible regurgitation and only 1 associated symptom investigated or treated for GORD.

Numerator – number in the denominator who had no visible regurgitation and only 1 associated symptom.

Denominator – number of infants and children investigated or treated for GORD.

Data source: Local data collection.

What the quality statement means for different audiences

Service providers (GP practices, community care providers, secondary care) ensure that there are practice arrangements and written clinical protocols to ensure that infants and children are not investigated or treated for GORD if they have no visible regurgitation and only 1 associated symptom.

Healthcare professionals (health visitors, midwives, paediatric nurses or GPs) ensure that they do not investigate or treat infants and children for GORD if they have only 1 associated symptom and no visible regurgitation.

Commissioners (clinical commissioning groups, NHS England, local authorities) ensure that the services they commission do not investigate or treat infants and children for GORD if they have only 1 associated symptom and no visible regurgitation.

Infants and children do not undergo tests or treatments for GORD if they are not regurgitating their feeds and if they only have 1 of the following symptoms: feeding problems such as refusing to feed, gagging or choking, discomfort or pain on a regular basis, poor growth, cough that does not go away, hoarseness or pneumonia.

Source guidance

Gastro-oesophageal reflux disease in children and young people. NICE guideline NG1 (2015, updated 2019), recommendation 1.1.6 (key priority for implementation)

Definitions of terms used in this quality statement

Symptoms associated with GORD

Symptoms that infants may present with include:

  • unexplained feeding difficulties (for example, refusing to feed, gagging or choking)

  • distressed behaviour

  • faltering growth

  • chronic cough

  • hoarseness

  • a single episode of pneumonia.

[NICE's guideline on gastro-oesophageal reflux disease in children and young people, recommendation 1.1.6 (key priority for implementation)]