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Rome IV Diagnostic Criteria for Infant Regurgitation

Symptom-based diagnosis of uncomplicated 'happy spitting' in a healthy infant.

Rome IV Diagnostic Criteria for Infant Regurgitation
Otherwise healthy infant, 3 weeks to 12 months of age
Regurgitation ≥2 times per day for ≥3 weeks
No retching, hematemesis, aspiration, apnea, failure to thrive, feeding or swallowing difficulty, or abnormal posturing
ResultCriteria not met

Does not meet Rome IV criteria for infant regurgitation; evaluate for GERD with complications or another cause of vomiting.

When to use

  • Thriving infant with frequent effortless spitting up and no warning signs, to distinguish physiologic regurgitation from pathologic GERD.

Formula

Diagnosis requires all of: otherwise healthy infant aged 3 weeks to 12 months; regurgitation ≥2 times/day for ≥3 weeks; absence of retching, hematemesis, aspiration, apnea, failure to thrive, feeding/swallowing difficulty, or abnormal posturing.

Pearls and pitfalls

  • Presence of any warning sign (poor weight gain, blood in emesis, respiratory symptoms) shifts the differential toward pathologic GERD or another diagnosis.

References

  1. Benninga MA, Faure C, Hyman PE, et al. Childhood Functional Gastrointestinal Disorders: Neonate/Toddler. Gastroenterology. 2016;150(6):1443-1455.