One thousand and four infants were screened for eligibility. Six hundred fifty-five (65.2%) were included at well baby clinics and 349 (34.8%) were recruited through the online advertisement. Twenty-five infants (2.49%) were excluded from analysis because of ex-prematurity (n=5), consultation of a health care professional for possible GER-related problems (n=17), or because caregivers considered their child’s GER symptoms as moderate to very severe (n=4, of which n=1 also consulted a health care professional for GER symptoms).
A total of 979 infants (47% male, median age 6 [0-24] months) were included in this study. Median I-GERQ-R score of all infants, regardless of age, was 6 (range: 0-27). Of all infants, 49 (5%) had a score of ≥16 which is currently considered ‘suggestive of GER-disease’.(5)
Correlations of total I-GERQ-R scores with age
Total I-GERQ-R scores, regurgitation- and colic-related subscores, correlated strongly with age (rs = -0.569, p<0.001; rs = -0.554, p<0.001 and rs = -0.380; p < 0.001 respectively) and are displayed in table 1.
Total I-GERQ-R scores (figure 1a), as well as regurgitation- and colic-related subscores (figure 1b) significantly decreased with age. A total score of ≥16 was most often seen in newborns aged 0-1 month (12/75, 16%). The percentage of cases with scores ≥16 rapidly decreased to 4% (3/68) at the age of 4-5 months and disappeared after the age of 15 months (see figure 2).
Correlations of separate I-GERQ-R items with age
When looking at all I-GERQ-R questions separately, regurgitation frequency, regurgitation quantity and hiccup frequency showed moderate and significant negative correlations with age (rs = -0.517, p<0.001; rs = -0. 488, p<0.001 and rs = -0.593; p < 0.001 respectively, see table 2). The items ‘stopping with eating soon after starting the meal’ and ‘more than usual crying or fussing’ did not show any correlation with age, the remaining I-GERQ-R items showed low or very low correlations with age (table 2). ‘Feeding refusal’ was the only I-GERQ-R item with a (very weak) positive correlation with age and was most frequently reported in infants aged 15 months and older.
Table 1: I-GERQ-R scores
|
Age (months) and number of patients
|
|
0-2 (n=198)
|
2-4 (n=157)
|
4-6 (n=129)
|
6-8 (n=115)
|
8-10
(n=81)
|
10-12
(n=59)
|
12-14
(n=52)
|
14-16 (n=61)
|
16-18 (n=36)
|
18-20 (n=37)
|
20-22 (n=23)
|
22-24 (n=31)
|
total I-GERQ-R score
|
10 (0-24)
|
9 (0-27)
|
7 (0-26)
|
6 (0-18)
|
5 (0-20)
|
4 (0-17)
|
4 (0-22)
|
3 (0-16)
|
3 (0-11)
|
4 (0-14)
|
2 (0-8)
|
2 (0-12)
|
regurgitation subscore
|
3 (0-8)
|
3 (0-9)
|
2 (0-7)
|
2 (1-8)
|
1 (0-6)
|
0 (0-3)
|
0 (0-6)
|
0 (0-5)
|
0 (0-5)
|
0 (0-3)
|
0 (0-4)
|
0 (0-4)
|
colic associated subscore
|
4 (0-11)
|
3 (0-11)
|
2 (0-8)
|
1 (0-11)
|
2 (0-9)
|
1 (0-12)
|
1 (0-9)
|
1 (0-5)
|
1 (0-7)
|
2 (0-10)
|
1 (0-6)
|
1 (0-7)
|
median and range of total I-GERQ-R scores and regurgitation- and colic associated subscores
Table 2: Correlation between I-GERQ-R questions and age (in months)
Question
|
Spearman’s rho
|
Effect size
|
P value
|
1. During the past week, how often did the baby usually spit-up (anything coming out of the mouth) during a 24-hour period?
|
-0.517
|
Moderate
|
<0.001
|
2. During the past week, how much did the baby usually spit-up (anything coming out of the mouth) during a typical episode?
|
-0.488
|
Moderate
|
<0.001
|
3. During the past week, how often did spitting up (anything coming out of the mouth) seem to be uncomfortable for the baby, for example, crying, fussing, irritability, etc.?
|
-0.296
|
Weak
|
<0.001
|
4. During the past week, how often did the baby refuse a feeding even when hungry?
|
0.133
|
Very weak
|
<0.001
|
5. During the past week, how often did the baby stop eating soon after starting even when hungry?
|
0.019
|
Very weak
|
ns
|
6. During the past week, did the baby cry a lot during or within 1 hour after feedings?
|
-0.326
|
Weak
|
<0.001
|
7. During the past week, did the baby cry or fuss more than usual?
|
-0.025
|
Very weak
|
ns
|
8. During the past week, on average how long did the baby cry or fuss during a 24 hour period?
|
-0.293
|
Weak
|
<0.001
|
9. During the past week, how often did the baby have hiccups?
|
-0.593
|
Moderate
|
<0.001
|
10. During the past week, how often did the baby have episodes of arching back?
|
-0.337
|
Weak
|
<0.001
|
11. During the past week, has the baby stopped breathing while awake or struggled to breathe?
|
-0.119
|
Very weak
|
<0.001
|
12. During the past week, has the baby turned blue or purple?
|
-0.062
|
Very weak
|
0.081
|
correlation between age and GER-related symptoms, as surveyed with the I-GERQ-R. Feeding refusal was the only symptom with a significant positive (very weak) correlation with age.
Regurgitation and crying symptoms over time
Regurgitation, for parents or caregivers defined as anything coming out of the mouth, was present in 70-79% of infants in the first 6 months of age (median 1-3 times a day) with a peak prevalence of 79% at the age of 1-2 months (figure 3a). Of infants aged 0-6 months (n=570) old that regurgitate daily (n=415, 73%), 251 (24%) regurgitated 1-3 times a day, 105 (18%) 3-6 times a day and 59 (10%) >6 times a day.
Between 7-12 months old, prevalence of regurgitation ranged between 44% and 15% and dropped further to 0% afterwards.
Crying symptoms in infants decreased faster than regurgitation symptoms: infants aged 0-4 months cried the most (median crying times of 10 minutes up to an hour, figure 3b).
Fifty-five percent of infants aged 4 months and older had a reported crying time of less than 10 minutes a day.
Association between regurgitation and colic subscores.
The regurgitation subscore showed a significant moderate correlation with colic-associated subscore of the I-GERQ-R (rs = 0.393; p<0.001).
Association between regurgitation and feeding problems
The regurgitation subscore did not correlate with the frequency of feeding refusal (rs = -0.049, p=0.125).