Indonesian pediatricians’ understanding and management of infant regurgitation based on Rome IV criteria

  • Fransesco Bernado Hubert Jonathan Faculty of Medicine, Universitas Indonesia, Jakarta
  • Agus T. Sridevi Faculty of Medicine, Universitas Indonesia, Jakarta
  • Brahmantyo A. Wicaksono Faculty of Medicine, Universitas Indonesia, Jakarta
  • Dewi Friska Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta
  • Badriul Hegar Department of Child Health, University of Indonesia Medical School/Dr. Cipto Mangunkusumo Hospital, Jakarta
Keywords: infant regurgitation; Rome IV criteria; GERD


Background The diagnostic criteria of infant regurgitation have been well elucidated in the Rome IV criteria and pediatricians have been informed of them. However, as a functional disorder, infant regurgitation is susceptible to misdiagnosis and inappropriate management.

Objective To assess pediatricians’ diagnostic knowledge of and therapeutic approach to infant regurgitation.

Methods We conducted a cross-sectional, analytical study using a questionnaire based on Rome IV criteria for infant regurgitation diagnosis and standardized guidelines for management. The questionnaire was face-level validated by an expert and tested for both reliability and correlation using 30 test respondents. The questionnaire was then distributed electronically to 131 randomized pediatricians, who were members of the Indonesian Pediatric Society DKI Jakarta branch and graduated from pediatric residency within year 2005-2019.

Results Sixty-seven (51%) pediatricians reported applying the Rome IV criteria in daily clinical practice. Pediatricians who used Rome IV as their source of knowledge achieved mean and median diagnostic knowledge scores of 14.87 (SD 2.540) and 16 (range 8–20), respectively, with no significant correlation between the usage of ROME IV and the pediatricians’ diagnostic understanding (P=0.110), and mean and median therapeutic knowledge scores of 9.10 (SD 2.264) and 10 (range 4–12), respectively, with no significant correlation between the usage of ROME IV and the pediatricians’ therapeutic approach (P=0.486). Pediatricians’ diagnostic knowledge and therapeutic approach were not significantly different with regards to their practice experience, specialist institution, workplaces, and source of information.

Conclusion The majority of pediatricians surveyed have good diagnostic and therapeutic knowledge scores with regards to handling of Rome IV infant regurgitation.

Author Biographies

Fransesco Bernado Hubert Jonathan, Faculty of Medicine, Universitas Indonesia, Jakarta



Agus T. Sridevi, Faculty of Medicine, Universitas Indonesia, Jakarta



Brahmantyo A. Wicaksono, Faculty of Medicine, Universitas Indonesia, Jakarta




1. Drossman D, Chang L, Kellow J, Chey W, Tack J, Whitehead W. ROME IV Functional gastrointestinal disorders for primary care and non-GI clinicians. Raleigh: The Rome Foundation; 2016. p. 82–3.
2. Trivi? I, Hojsak I. Initial diagnosis of functional gastrointestinal disorders in children increases a chance for resolution of symptoms. Pediatr Gastroenterol Hepatol Nutr. 2018;1:264–70. DOI:
3. Salvatore S, Barberi S, Borrelli O, Castellazzi A, Di Mauro D, Di Mauro G, et al. Pharmacological interventions on early functional gastrointestinal disorders. Ital J Pediatr. 2016;42:68. DOI:
4. Cai W, Bharadia L, Juffrie M, Cheah FC, Quak SH, Titapant V, et al. Prevalence and management of functional gastrointestinal disorders in infants: an Asian perspective. Pediatr Gastroenterol Hepatol Nutr. 2018;21:76-7. DOI:
5. Van Tilburg MAL, Hyman PE, Walker L, Rouster A, Palsson OS, Kim SM, et al. Prevalence of functional gastrointestinal disorders in infants and toddlers. J Pediatr. 2015;166:684–9. DOI:
6. Palsson OS, Whitehead WE, van Tilburg MA, Chang L, Chey W, Crowell MD, et al. Rome IV diagnostic questionnaires and tables for investigators and clinicians. Gastroenterology. 2016 :S0016-5085(16)00180-3. DOI:
7. Hegar B, Boediarso A, Firmansyah A, Vandenplas Y. Investigation of regurgitation and other symptoms of gastroesophageal reflux in Indonesian infants. World J Gastroenterol. 2004;10:1795–7. DOI:
8. Nelson SP, Chen EH, Syniar GM, Christoffel KK. Prevalence of symptoms of gastroesophageal reflux during infancy. A pediatric based survey. Arch Pediatr Adolesc Med. 1997;151:569-72. DOI:
9. Hegar B, Satari DHI, Sjarif DR, Vandenplas Y. Regurgitation and gastroesophageal reflux disease in six to nine months old Indonesian infants. Pediatr Gastroenterol Hepatol Nutr. 2013;16:240–7. DOI:
10. Hegar B, Dewanti NR, Kadim M, Alatas S, Firmansyah A, Vandenplas Y. Natural evolution of regurgitation in healthy infants. Acta Paediatr. 2009;98:1189–93. DOI:
11. Santen SA, Hemphill RR, Pusic M. The responsibility of physicians to maintain competency. JAMA. 2020;323:117–8. DOI:
12. Ahmed K, Wang TT, Ashrafian H, Layer GT, Athanasiou T. The effectiveness of continuing medical education for specialist recertification. Can Urol Assoc J. 2013;7:266-72. DOI:
13. Levy R, Dubrowski A, Amin H, Bismilla Z. Procedural skills in paediatric residency: re-evaluating the competencies. Paediatr Child Health. 2014;19:180–4. DOI:
14. Mansouri M, Lockyer J. A meta-analysis of continuing medical education effectiveness. J Contin Educ Health Prof. 2007;27:6-15. DOI:
15. Williams JG. Are online learning modules an effective way to deliver hand trauma management continuing medical education to emergency physicians? Plast Surg (Oakv). 2014;22:75–8. PMCID:
16. Mustika R, Nishigori H, Ronokusumo S, Scherpbier A. The odyssey of medical education in Indonesia. TAPS. 2019;4:4–8. DOI:
17. van Zanten M. The association between medical education accreditation and examination performance of internationally educated physicians seeking certification in the United States. Perspect Med Educ. 2015;4:142-5. DOI: 18. Faber J, Fonseca LM. How sample size influences research outcomes. Dental Press J Orthod. 2014;19:27–9. DOI:
19. Burke LG, Frakt AB, Khullar D, Orav EJ, Jha AK. Association between teaching status and mortality in US hospitals. JAMA. 2017 May 23;317:2105–13. DOI:
20. Allison JJ, Kiefe CI, Weissman NW, Person SD, Rousculp M, Canto JG, et al. Relationship of hospital teaching status with quality of care and mortality for Medicare patients with acute MI. JAMA. 2000;284:1256–62. DOI:
21. Davari M, Khorasani E, Tigabu BM. Factors influencing prescribing decisions of physicians: a review. Ethiop J Health Sci. 2018;28:795–804. DOI:
22. Baird D, Harker D, Karmes A. Diagnosis and treatment of gastroesophageal reflux in infants and children. Am Fam Physician. 2015;92:705–14. PMID: 26554410.
23. Wolke D, Bilgin A, Samara M. Systematic review and meta-analysis: fussing and crying durations and prevalence of colic in infants. J Pediatr. 2017;185:55-61.e4. DOI:
24. Salvatore S, Abkari A, Cai W, Catto-Smith A, Cruchet S, Gottrand F, et al. Review shows that parental reassurance and nutritional advice help to optimise the management of functional gastrointestinal disorders in infants. Acta Paediatr. 2018;107:1512–20. DOI:
25. Kwok TC, Ojha S, Dorling J. Feed thickeners in gastro-oesophageal reflux in infants. BMJ Paediatr Open. 2018;2:e000262. DOI:
26. Hegar B, Rantos R, Firmansyah A, De Schepper J, Vandenplas Y. Natural evolution of infantile regurgitation versus the efficacy of thickened formula. J Pediatr Gastroenterol Nutr. 2008;47:26–30. DOI:
27. Ferguson TD. Gastroesophageal reflux: regurgitation in the infant population. Crit Care Nurs Clin North Am. 2018;30:167–77. DOI:
28. Omari T. Gastroesophageal reflux in infants: can a simple left side positioning strategy help this diagnostic and therapeutic conundrum? Minerva Pediatr. 2008;60:193–200. PMID: 18449136.
29. Omari T, Rommel N, Staunton E, Lontis R, Goodchild L, Haslam R, et al. Paradoxical impact of body positioning on gastroesophageal reflux and gastric emptying in the premature neonate. J Pediatr. 2004;145:194–200. DOI:
30. Leung AK, Hon KL. Gastroesophageal reflux in children: an updated review. Drugs Context. 2019;8:212591. DOI:
How to Cite
Jonathan F, Sridevi A, Wicaksono B, Friska D, Hegar B. Indonesian pediatricians’ understanding and management of infant regurgitation based on Rome IV criteria. PI [Internet]. 5Dec.2022 [cited 21Apr.2024];62(6):373-1. Available from:
Pediatric Gastrohepatology
Received 2021-10-11
Accepted 2022-12-05
Published 2022-12-05