Chrildren and Acid Reflux

We have been asked to research opinions towards acid reflux and GERD. Please take this anonymous survey and share your views. Your response to this anonymous survey are completely confidential and will help ensure future reflux awareness and education.

Thank you for your participation.

1. Do you have a child that suffers from GERD, gastrointestinal problems or acid reflux?

Do you have a child that suffers from GERD, gastrointestinal problems or acid reflux? Yes

2. How old is this child?

How old is this child? 0-24 months

2-5 years old

6-9 years old

10+ years old

3. What reflux medication(s) do you use?

What reflux medication(s) do you use? Maalox

Mylanta

Prevacid

Zantac

Prilosec

Nexium

Other (please specify)

4. Does your child like the taste of his/her reflux medication?

Does your child like the taste of his/her reflux medication? Yes

5. Have you ever asked your pharmacist to flavor your child's reflux medication to mask the bitter taste?

Have you ever asked your pharmacist to flavor your child's reflux medication to mask the bitter taste? Yes

To help us understand your answers better, we’d like to know a bit more about you. This survey is anonymous and your answers are completely confidential.

6. What is your gender?

What is your gender? Male

Female

7. What is your age range?

What is your age range? 17 or under

18-25 years

26-41 years

42-59 years

60 or over

8. How many people are in your household?

How many people are in your household? 1

3-4

5-6

7 or more

9. In which region do you live?

In which region do you live? Northeast (CT,MA,ME,NH,RI,VT)

Mid-Atlantic (NJ,NY,PA)

South Atlantic (DC,DE,FL,GA,MD,NC,SC,VA,WV)

South Central (AL,AR,KY,LA,MS,OK,TN,TX)

Midwest (IA,IL,IN,KA,MI,MN,MO,ND,NE,OH,SD,WI)

Mountain (AZ,CO,ID,MT,NM,NV,UT,WY)

Pacific (AK,CA,HI,OR,WA)

I do not live in the U.S.

10. What is the highest degree or level of education that you have completed?

What is the highest degree or level of education that you have completed? Less than high school

High school

Associate degree (for example: AA, AS)

Bachelor’s degree

Master’s degree

Doctorate or professional degree (MD, DDS, etc.)

11. For survey results, please confirm your email below.

Note: We respect your privacy as much as your opinion. This survey is anonymous and your email address will not be saved with your answers. Your email address will never be sold or shared with a third party.

For survey results, please confirm your email below. Note: We respect your privacy as much as your opinion. This survey is anonymous and your email address will not be saved with your answers. Your email address will never be sold or shared with a third party.