{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T19:56:01Z","timestamp":1793735761049,"version":"4.6.1"},"reference-count":31,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,4,8]],"date-time":"2021-04-08T00:00:00Z","timestamp":1617840000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,4,8]],"date-time":"2021-04-08T00:00:00Z","timestamp":1617840000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["APP1065898"],"award-info":[{"award-number":["APP1065898"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Gastro-oesophageal reflux (GOR) is a common physiological state in infants and young children, with gastro-oesophageal reflux disease (GORD) its pathological manifestation. Management of GOR\/GORD requires elimination of possible underlying causes, parental reassurance, modification of feeding and symptom mitigation, monitoring, and referral to paediatricians if warning signs are present. Published clinical practice guidelines (CPGs) seek to support clinicians and improve management. This study aimed to measure the proportion of Australian GOR\/GORD paediatric care that was in line with CPG recommendations. National and international CPGs for GOR\/GORD were systematically identified and candidate indicators extracted; a Delphi process selected 32 indicators relevant to Australian paediatric care in 2012 and 2013. Medical records were identified in General Practices, the offices of general paediatricians, Emergency Departments and inpatient settings. Adherence to indicators was assessed by nine trained paediatric nurses undertaking retrospective medical record review. Medical records were reviewed in 115 healthcare sites; identifying 285 children, three-quarters aged\u2009&lt;\u20091\u00a0year, who had 359 visits for management of GOR\/GORD; 2250 eligible indicator assessments were performed. Estimated adherence rates are reported for 21 indicators with\u2009\u2265\u200925 assessments. Five indicators recommending differential diagnostic tests (e.g., urinalysis) for infants presenting with recurrent regurgitation and poor weight gain had\u2009~\u200910% adherence; conversely, avoidance of unrecommended tests (e.g., barium swallow and meal) was high (99.8% adherence: 95% CI 97.0\u2013100). Avoidance of prescription of acid-suppression medication for <jats:italic>infants<\/jats:italic> at the first presentation was higher if they were healthy and thriving (86.9% adherence: 95% CI 86.0\u201396.8), intermediate if they had feeding refusal (73.1%: 95% CI 56.0\u201386.3) and lower if they presented with irritability and unexplained crying (58.8%: 95% CI 28.2\u201385.0). A guideline targeting Australian health professionals caring for infants and children with GOR\/GORD is warranted, highlighting the importance of differential diagnostic testing and avoidance of acid-suppression medication in infants.<\/jats:p>","DOI":"10.1038\/s41598-021-87369-7","type":"journal-article","created":{"date-parts":[[2021,4,8]],"date-time":"2021-04-08T10:13:19Z","timestamp":1617876799000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Assessing the appropriateness of the management of gastro-oesophageal reflux in Australian children: a population-based sample survey"],"prefix":"10.1038","volume":"11","author":[{"given":"Gaston","family":"Arnolda","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harriet","family":"Hiscock","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Moore","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Glen","family":"Farrow","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter D.","family":"Hibbert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louise K.","family":"Wiles","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hseun P.","family":"Ting","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte J.","family":"Molloy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meagan","family":"Warwick","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Braithwaite","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,4,8]]},"reference":[{"issue":"4","key":"87369_CR1","doi-asserted-by":"publisher","first-page":"498","DOI":"10.1097\/MPG.0b013e3181b7f563","volume":"49","author":"Y Vandenplas","year":"2009","unstructured":"Vandenplas, Y. et al. Pediatric gastroesophageal reflux clinical practice guidelines: Joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). J. Pediatr. Gastroenterol. Nutr. 49(4), 498\u2013547 (2009).","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"issue":"6","key":"87369_CR2","doi-asserted-by":"publisher","first-page":"1061","DOI":"10.1542\/peds.109.6.1061","volume":"109","author":"AJ Martin","year":"2002","unstructured":"Martin, A. J. et al. Natural history and familial relationships of infant spilling to 9 years of age. Pediatrics 109(6), 1061\u20131067 (2002).","journal-title":"Pediatrics"},{"issue":"7","key":"87369_CR3","doi-asserted-by":"publisher","first-page":"1189","DOI":"10.1111\/j.1651-2227.2009.01306.x","volume":"98","author":"B Hegar","year":"2009","unstructured":"Hegar, B. et al. Natural evolution of regurgitation in healthy infants. Acta P\u00e6diatr. 98(7), 1189\u20131193 (2009).","journal-title":"Acta P\u00e6diatr."},{"issue":"4","key":"87369_CR4","doi-asserted-by":"publisher","first-page":"348","DOI":"10.3111\/13696990903378680","volume":"12","author":"S Nelson","year":"2009","unstructured":"Nelson, S. et al. Pediatric gastroesophageal reflux disease and acid-related conditions: Trends in incidence of diagnosis and acid suppression therapy. J. Med. Econ. 12(4), 348\u2013355 (2009).","journal-title":"J. Med. Econ."},{"issue":"12","key":"87369_CR5","doi-asserted-by":"publisher","first-page":"1767","DOI":"10.1007\/s00431-012-1807-4","volume":"171","author":"L Martigne","year":"2012","unstructured":"Martigne, L. et al. Prevalence and management of gastroesophageal reflux disease in children and adolescents: A nationwide cross-sectional observational study. Eur. J. Pediatr. 171(12), 1767\u20131773 (2012).","journal-title":"Eur. J. Pediatr."},{"issue":"5","key":"87369_CR6","first-page":"268","volume":"41","author":"K Allen","year":"2012","unstructured":"Allen, K. & Ho, S. Gastro-oesophageal reflux in children: What\u2019s the worry?. Aust. Fam. Physician. 41(5), 268\u2013272 (2012).","journal-title":"Aust. Fam. Physician."},{"issue":"1","key":"87369_CR7","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1016\/j.jpeds.2015.08.064","volume":"168","author":"CM Stark","year":"2016","unstructured":"Stark, C. M. & Nylund, C. M. Side effects and complications of proton pump inhibitors: A pediatric perspective. J. Pediatr. 168(1), 16\u201322 (2016).","journal-title":"J. Pediatr."},{"issue":"4","key":"87369_CR8","doi-asserted-by":"publisher","first-page":"505","DOI":"10.1097\/MPG.0b013e3182a69912","volume":"58","author":"P Quitadamo","year":"2014","unstructured":"Quitadamo, P. et al. European pediatricians\u2019 approach to children with GER symptoms: Survey of the implementation of 2009 NASPGHAN-ESPGHAN guidelines. J. Pediatr. Gastroenterol. Nutr. 58(4), 505\u2013509 (2014).","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"issue":"3","key":"87369_CR9","doi-asserted-by":"publisher","first-page":"356","DOI":"10.1097\/MPG.0000000000000408","volume":"59","author":"P Quitadamo","year":"2014","unstructured":"Quitadamo, P. et al. Do pediatricians apply the 2009 NASPGHAN-ESPGHAN guidelines for the diagnosis and management of gastroesophageal reflux after being trained?. J. Pediatr. Gastroenterol. Nutr. 59(3), 356\u2013359 (2014).","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"issue":"11","key":"87369_CR10","doi-asserted-by":"publisher","first-page":"1113","DOI":"10.1001\/jama.2018.0162","volume":"319","author":"J Braithwaite","year":"2018","unstructured":"Braithwaite, J. et al. Quality of health care for children in Australia, 2012\u20132013. JAMA 319(11), 1113\u20131124 (2018).","journal-title":"JAMA"},{"issue":"4","key":"87369_CR11","doi-asserted-by":"publisher","first-page":"e007749","DOI":"10.1136\/bmjopen-2015-007749","volume":"5","author":"TD Hooper","year":"2015","unstructured":"Hooper, T. D. et al. CareTrack Kids-part 2. Assessing the appropriateness of the healthcare delivered to Australian children: Study protocol for a retrospective medical record review. BMJ Open 5(4), e007749 (2015).","journal-title":"BMJ Open"},{"issue":"4","key":"87369_CR12","doi-asserted-by":"publisher","first-page":"e007748","DOI":"10.1136\/bmjopen-2015-007748","volume":"5","author":"LK Wiles","year":"2015","unstructured":"Wiles, L. K. et al. CareTrack Kids-part 1. Assessing the appropriateness of healthcare delivered to Australian children: Study protocol for clinical indicator development. BMJ Open 5(4), e007748 (2015).","journal-title":"BMJ Open"},{"key":"87369_CR13","volume-title":"The RAND\/UCLA Appropriateness Method User's Manual","author":"K Fitch","year":"2001","unstructured":"Fitch, K., Bernstein, S. J., Aguilar, M. D., Burnand, B. & LaCalle, J. R. The RAND\/UCLA Appropriateness Method User\u2019s Manual (Rand Corp, 2001)."},{"issue":"6","key":"87369_CR14","doi-asserted-by":"publisher","first-page":"e20476","DOI":"10.1371\/journal.pone.0020476","volume":"6","author":"R Boulkedid","year":"2011","unstructured":"Boulkedid, R., Abdoul, H., Loustau, M., Sibony, O. & Alberti, C. Using and reporting the Delphi method for selecting healthcare quality indicators: A systematic review. PLoS ONE 6(6), e20476 (2011).","journal-title":"PLoS ONE"},{"issue":"9","key":"87369_CR15","doi-asserted-by":"publisher","first-page":"1695","DOI":"10.1016\/j.techfore.2011.04.005","volume":"78","author":"F Hasson","year":"2011","unstructured":"Hasson, F. & Keeney, S. Enhancing rigour in the Delphi technique research. Technol. Forecast. Soc. Change. 78(9), 1695\u20131704 (2011).","journal-title":"Technol. Forecast. Soc. Change."},{"issue":"3","key":"87369_CR16","doi-asserted-by":"publisher","first-page":"516","DOI":"10.1097\/MPG.0000000000001889","volume":"66","author":"R Rosen","year":"2018","unstructured":"Rosen, R. et al. Pediatric gastroesophageal reflux clinical practice guidelines: Joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). J. Pediatr. Gastroenterol. Nutr. 66(3), 516 (2018).","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"issue":"1","key":"87369_CR17","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1111\/jpc.12983","volume":"52","author":"CN Kirby","year":"2016","unstructured":"Kirby, C. N., Segal, A. Y., Hinds, R., Jones, K. M. & Piterman, L. Infant gastro-oesophageal reflux disease (GORD): Australian GP attitudes and practices. J. Paediatr. Child Health. 52(1), 47\u201353 (2016).","journal-title":"J. Paediatr. Child Health."},{"issue":"3","key":"87369_CR18","doi-asserted-by":"publisher","first-page":"767","DOI":"10.1016\/j.jpeds.2014.11.030","volume":"166","author":"D Gieruszczak-Bialek","year":"2015","unstructured":"Gieruszczak-Bialek, D., Konarska, Z., Skorka, A., Vandenplas, Y. & Szajewska, H. No effect of proton pump inhibitors on crying and irritability in infants: Systematic review of randomized controlled trials. J. Pediatr. 166(3), 767\u201370.e3 (2015).","journal-title":"J. Pediatr."},{"issue":"4","key":"87369_CR19","doi-asserted-by":"publisher","first-page":"514","DOI":"10.1016\/j.jpeds.2008.09.054","volume":"154","author":"SR Orenstein","year":"2009","unstructured":"Orenstein, S. R., Hassall, E., Furmaga-Jablonska, W., Atkinson, S. & Raanan, M. Multicenter, double-blind, randomized, placebo-controlled trial assessing the efficacy and safety of proton pump inhibitor lansoprazole in infants with symptoms of gastroesophageal reflux disease. J. Pediatr. 154(4), 514\u2013520 (2009).","journal-title":"J. Pediatr."},{"issue":"2","key":"87369_CR20","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1097\/MPG.0b013e3182a3b04e","volume":"58","author":"P De Bruyne","year":"2014","unstructured":"De Bruyne, P., Christiaens, T., Vander Stichele, R. & Van Winckel, M. Changes in prescription patterns of acid-suppressant medications by Belgian pediatricians: Analysis of the national database [1997\u20132009]. J. Pediatr. Gastroenterol. Nutr. 58(2), 220\u2013225 (2014).","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"issue":"1\/2","key":"87369_CR21","first-page":"73","volume":"37","author":"CN Kirby","year":"2008","unstructured":"Kirby, C. N., Piterman, L., Nelson, M. & Dent, J. Gastro-oesophageal reflux disease: Impact of guidelines on GP management. Aust. Fam. Physician. 37(1\/2), 73 (2008).","journal-title":"Aust. Fam. Physician."},{"key":"87369_CR22","volume-title":"Infant Feeding Guidelines: Information for health workers","author":"National Health and Medical Research Council","year":"2012","unstructured":"National Health and Medical Research Council. Infant Feeding Guidelines: Information for health workers (National Health and Medical Research Council, 2012)."},{"issue":"5","key":"87369_CR23","doi-asserted-by":"publisher","first-page":"265","DOI":"10.5694\/j.1326-5377.2010.tb03504.x","volume":"192","author":"PG Gibson","year":"2010","unstructured":"Gibson, P. G. et al. CICADA: Cough in children and adults: Diagnosis and assessment. Australian cough guidelines summary statement. Med. J. Aust. 192(5), 265\u2013271 (2010).","journal-title":"Med. J. Aust."},{"issue":"2","key":"87369_CR24","doi-asserted-by":"publisher","first-page":"109","DOI":"10.5694\/j.1326-5377.2008.tb01534.x","volume":"188","author":"AS Kemp","year":"2008","unstructured":"Kemp, A. S. et al. Guidelines for the use of infant formulas to treat cows milk protein allergy: An Australian consensus panel opinion. Med. J. Aust. 188(2), 109 (2008).","journal-title":"Med. J. Aust."},{"issue":"2","key":"87369_CR25","first-page":"25","volume":"25","author":"JC Anderson","year":"2017","unstructured":"Anderson, J. C. Infant reflux-not as simple as we might think. Breastfeeding Rev. 25(2), 25 (2017).","journal-title":"Breastfeeding Rev."},{"issue":"12","key":"87369_CR26","doi-asserted-by":"publisher","first-page":"1511","DOI":"10.1586\/17474124.2015.1093932","volume":"9","author":"Y Vandenplas","year":"2015","unstructured":"Vandenplas, Y. & Hauser, B. An updated review on gastro-esophageal reflux in pediatrics. Expert Rev. Gastroenterol. Hepatol. 9(12), 1511\u20131521 (2015).","journal-title":"Expert Rev. Gastroenterol. Hepatol."},{"issue":"5","key":"87369_CR27","doi-asserted-by":"publisher","first-page":"e168495","DOI":"10.1542\/peds.2013-0421","volume":"131","author":"JR Lightdale","year":"2013","unstructured":"Lightdale, J. R. & Gremse, D. A. Gastroesophageal reflux: management guidance for the pediatrician. Pediatric 131(5), e168495 (2013).","journal-title":"Pediatric"},{"key":"87369_CR28","unstructured":"N National Collaborating Centre for Women's Children's Health (UK). Gastro-Oesophageal Reflux Disease: Recognition, Diagnosis and Management in Children and Young People (National Institute for Health and Care Excellence (UK), 2015). https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK293624\/"},{"issue":"26","key":"87369_CR29","doi-asserted-by":"publisher","first-page":"2635","DOI":"10.1056\/NEJMsa022615","volume":"348","author":"EA McGlynn","year":"2003","unstructured":"McGlynn, E. A. et al. The quality of health care delivered to adults in the United States. N. Engl. J. Med. 348(26), 2635\u20132645 (2003).","journal-title":"N. Engl. J. Med."},{"key":"87369_CR30","doi-asserted-by":"crossref","unstructured":"Choonara, I. Rational Prescribing is Important in All Settings (2013).","DOI":"10.1136\/archdischild-2013-304559"},{"key":"87369_CR31","first-page":"9","volume":"2017","author":"SKG Tonkin-Crine","year":"2017","unstructured":"Tonkin-Crine, S. K. G. et al. Clinician-targeted interventions to influence antibiotic prescribing behaviour for acute respiratory infections in primary care: an overview of systematic reviews. Cochrane Database Syst. Rev. 2017, 9 (2017).","journal-title":"Cochrane Database Syst. Rev."}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-87369-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-87369-7","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-87369-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,3]],"date-time":"2022-12-03T06:28:04Z","timestamp":1670048884000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-87369-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,8]]},"references-count":31,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021,12]]}},"alternative-id":["87369"],"URL":"https:\/\/doi.org\/10.1038\/s41598-021-87369-7","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4,8]]},"assertion":[{"value":"3 September 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 March 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 April 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"7744"}}