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Gastroesophageal reflux in infants: can a simple left side positioning strategy help this diagnostic and therapeutic conundrum?

Gastroesophageal reflux (GER) is a very common condition that interrupts feeding and sleep routine in up to 30% of newborn infants. ''GER disease'' affects 3-5% of newborns and is defined when more serious complications are associated with GER. The diagnosis and treatment of GER disease in infants is fraught with difficulty due to the wide range of clinical presentations and the lack of diagnostic modalities and appropriate diagnostic criteria. These issues lead to failure to accurately diagnose reflux disease, or alternatively, over-diagnosis of reflux disease leading to the prescription of unnecessary and costly acid suppression therapies and surgical interventions. When faced with a newborn infant with GER, medical professionals prefer to offer parents a non-pharmacological therapy and/or some ''common sense'' advice rather than a drug. To date the only non-pharmacological intervention proven to reduce reflux is the positioning of infants on their left side after feeding. Despite this clear evidence, a left side positioning strategy has yet to be accepted by the wider medical community due to the current lack of appropriate evidence-based guidelines. This review will evaluate the basis left-side positioning as a simple, non-pharmacological approach to the treatment of GER related symptoms in preterm and term infants 0-6 months of age.