This site is intended for healthcare professionals

Go to /sign-in page

You can view 5 more pages before signing in

Red flag symptoms suggesting a disorder other than GOR (GORD)

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

'Red flag' symptoms suggesting disorders other than GOR

Symptoms and signs

Possible diagnostic implications

Suggested actions

Gastrointestinal

Frequent, forceful (projectile) vomiting

May suggest hypertrophic pyloric stenosis in infants up to 2 months old

Paediatric surgery referral

Bile-stained (green or yellow-green) vomit

May suggest intestinal obstruction

Paediatric surgery referral

Haematemesis (blood in vomit) with the exception of swallowed blood, for example, following a nose bleed or ingested blood from a cracked nipple in some breast-fed infants

May suggest an important and potentially serious bleed from the oesophagus, stomach or upper gut

Specialist referral

Onset of regurgitation and/or vomiting after 6 months old or persisting after 1 year old

Late onset suggests a cause other than reflux, for example a urinary tract infection. Persistence suggests an alternative diagnosis

Urine microbiology investigation

Specialist referral

Blood in stool

 

May suggest a variety of conditions, including bacterial gastroenteritis, infant cows' milk protein allergy or an acute surgical condition

Stool microbiology investigation

Specialist referral

Abdominal distension, tenderness or palpable mass

May suggest intestinal obstruction or another acute surgical condition

Paediatric surgery referral

Chronic diarrhoea

May suggest cows' milk protein allergy

Specialist referral

Systemic

Appearing unwell

Fever

May suggest infection

Clinical assessment and urine microbiology investigation

Specialist referral

Dysuria

May suggest urinary tract infection

Clinical assessment and urine microbiology investigation

Specialist referral

Bulging fontanelle

May suggest raised intracranial pressure, for example, due to meningitis

Specialist referral

Rapidly increasing head circumference (more than 1 cm per week)

Persistent morning headache, and vomiting worse in the morning

May suggest raised intracranial pressure, for example, due to hydrocephalus or a brain tumour

Specialist referral

Altered responsiveness, for example, lethargy or irritability

May suggest an illness such as meningitis

Specialist referral

Infants and children with, or at high risk of, atopy

may suggest cows' milk protein allergy

Specialist referral

Perform an urgent (same day) upper GI contrast study for infants with unexplained bile-stained vomiting. Explain to the parents and carers that this is needed to rule out serious disorders such as intestinal obstruction due to mid-gut volvulus.

Consider an upper GI contrast study for children and young people with a history of bile-stained vomiting, particularly if it is persistent or recurrent.

Offer an upper GI contrast study for children and young people with a history of GORD presenting with dysphagia.

Arrange an urgent specialist hospital assessment to take place on the same day for infants younger than 2 months with progressively worsening or forceful vomiting of feeds, to assess them for possible hypertrophic pyloric stenosis.

 

Reference:


Create an account to add page annotations

Add information to this page that would be handy to have on hand during a consultation, such as a web address or phone number. This information will always be displayed when you visit this page

The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

Connect

Copyright 2024 Oxbridge Solutions Limited, a subsidiary of OmniaMed Communications Limited. All rights reserved. Any distribution or duplication of the information contained herein is strictly prohibited. Oxbridge Solutions receives funding from advertising but maintains editorial independence.