Table 2.

‘Red Flag’ symptoms and signs that suggest disorders other than GERD

Symptoms and signs	Remarks
General:
-Weight loss -Lethargy -Fever -Excessive irritability/pain	Suggesting a variety of conditions, including systemic infections.
-Dysuria	May suggest urinary tract infection, especially in infants and young children.
-Onset of regurgitation/vomiting >6 months or increasing/persisting >12–18 months of age	Late onset as well as symptoms increasing or persisting after infancy, based on natural course of the disease, may indicate a diagnosis other than GERD.
Neurological:
-Bulging fontanel/rapidly increasing head circumference	May suggest raised intracranial pressure for example due to meningitis, brain tumor or hydrocephalus.
-Seizures
-Macro/microcephaly
Gastro-intestinal
-Persistent forceful vomiting	Indicative of hypertrophic pyloric stenosis (infants up to 2 months old)
-Nocturnal vomiting	May suggest increased intracranial pressure
-Bilious vomiting	Regarded as symptom of intestinal obstruction. Possible causes include Hirschsprung disease, intestinal atresia or mid-gut volvulus or intussusception.
-Hematemesis	Suggests a potentially serious bleed from the esophagus, stomach or upper gut, possibly GERD-associated, occurring from acid-peptic disease1, Mallory-Weiss tear2 or reflux-esophagitis.
-Chronic diarrhea	May suggest food protein-induced gastroenteropathy3.
-Rectal bleeding	Indicative of multiple conditions, including bacterial gastroenteritis, inflammatory bowel disease, as well as acute surgical conditions and food protein-induced gastroenteropathy rectal bleeding3 (bleeding caused by proctocolitis).
-Abdominal Distension	Indicative of obstruction, dysmotility, or anatomic abnormalities

¹Especially with NSAID use

²Associated with vomiting

³More likely in infants with eczema and/or a strong family history of atopic disease