Observations

Niamh used to vomit regularly, particularly during or after feeds and as a result was slow to gain weight as a baby. On occasions we used to see her repeatedly swallowing with a look on her face like she disliked the taste/sensation in her mouth. We believe this was food/acid refluxing and pH studies revealed this was the case.

Keeping the child in a permanently inclined position (during and after feeding) is believed to help relieve symptoms simply by sheer gravity. I have learned that a 20cm incline is the minimum incline required to be effective.

In adults, sleeping on the left side has been medically reported to reduce the incidence of reflux but we actually found that lying Niamh inclined on her right side assisted the emptying of her stomach and thus reduced the duration of her discomfort.

 - Acid Supressing Drugs - Drugs like Omerazole (Losec), Lansoprazole (Prevacid/Zoton), work by actually suppressing acid production in the stomach. Another drug called
  Ranitidine (Zantac) also reduces acid production but by a different chemical mechanism, so these drugs are often prescribed together.

 - Anti Sickness Drugs - Drugs like Ondansatron (Zofran) work by reducing the activity of the vagus nerve which is responsible for activating the vomiting centre.

 - Prokinetic Drugs - Drugs like Domperidone (Motilium) or low dose Erythromycin antibiotic, speed up the emptying of the stomach, meaning there is less opportunity for
  acid to sit in the stomach and reflux.

 - Anti Allergy Drugs - In response to allergy, the stomach and intestines can become inflamed, causing vomiting. It is therefore believed that medications that suppress
  the body's usual immune response (inflamation) may help reduce vomiting in cases of reflux. Drugs like Sodium Cromoglicate (Nalcrom) and Vallergan (Alimemazine) may
  help prevent inflammation and symptoms from occurring. Vallergan has the added property of being a local muscle relaxant which reduces the urge to retch thus
  reducing pressure on the gullet muscle hence reducing reflux.

 - Antacids like pepto-bismol, alka-selter (sodium bicarbonate) directly reduce the acidity of the stomach acid on contact and others known as mucosal
  protectants like Gavison and Sucraflate (Antepsin) have the added benefit of providing a barrier protection to the stomach lining whilst neutralising acid.

As reflux is more likely to become a problem when the stomach is full, it is believed that where possible, feeding a child smaller amounts and more frequently (thus never allowing the stomach to become full) may help.
This is a not an easy option. It may mean a complete lifestyle change as it may involve feeding a child every few hours through the day and night. It is made slightly easier if you have a child who is tube fed as they do not have to be woken to feed - unfortunately you do have to be awake.

If your child is tube-fed and using a feeding pump, it may be that their optimal comfort is taking a small feed and delivering this over a few hours, allowing the child a few hours break then starting again - as I said - this is a lifestyle change and can be absolutely exhausting so it is not practical for everyone.

In a small number of cases where medication has been unsuccessful, Reflux may be solved by a key hole surgical procedure called a "fundoplication" in which the gullet muscle (oesophageal sphincter) is strengthened by wrapping it round itself and tightening it.
Niamh had two of these performed but she was still able to vomit, so they do not work for every child.

Another procedure that may help reflux is the widening the sphincter muscle that allows digested feed out of the stomach and into the intestine. It is believed that this may assist in stomach empting thus reducing the volume in the stomach that could be refluxed.
This can either be stretched or surgically widened using a procedure called Pyloroplasty.