For neurologically impaired children with severe GERD, medical therapy should be tried before anti-reflux surgery?

• A. No, surgery is first-line
• B. Yes, but only in mild cases
• C. Yes, aggressive medical therapy trials (anti-reflux meds, PPI, dietary changes, and positioning) should be tried before considering surgery
• D. Medical therapy is contraindicated

Answer: (C)

Neurologically impaired children with severe GERD are managed best with a stepwise approach, starting with aggressive medical therapy and supportive measures before considering surgery. Reducing acidity and reflux episodes through acid suppression—using a proton pump inhibitor or an H2 blocker—helps heal the esophagus and decrease symptoms. Anti-reflux medications that can improve motility or lower reflux may be used as appropriate, but their effectiveness varies and safety is important to consider in kids. Dietary changes, such as smaller, more frequent feeds and thickened liquids, along with positioning strategies (keeping the child upright after feeds and elevating the head of the bed), can significantly lessen reflux and the risk of aspiration. If GERD remains uncontrolled or complications like recurrent aspiration or poor growth persist despite optimized medical therapy, then surgical options can be considered.