Infant GERD

Four month old infant with h/o congenital diaphragmatic hernia, suspected neurodevelopmental disorder, and prematurity presents with regular spitting up and vomiting after meals. Infant sometimes refuses feeds and is fussy/irritable while spitting up; back arching often noted s/p feeds. Parents report recent hospital admission for pneumonia. Failure to gain weight, no palpable abdominal olive on exam.

• Treatment

  • Two week trial of maintaining infant upright during day, reducing feeding volumes while increasing frequency, and use of thickening agents, e.g. 1 tablespoon rice cereal per ounce of formula

  • Failure of conservative therapy: Trial of ranitidine 5 mg/kg/day divided every 12 hours for 4 weeks

  • No response to ranitidine: Refer to pediatric gastroenterology

• Parents counseled that GERD generally resolves by 1 year of age

• Parents encouraged to contact provider if fever, apnea, or persistent vomiting/constipation develops

Notes

• Differential diagnosis

  • Gastroesophageal reflux, i.e. “happy spitters”

    • Similar to GERD, but non-pathologic

    • Occurs in all infants to varying degrees

    • Normal weight gain and little difficulty with feeding

  • Infant colic

  • Hiatal hernia

  • Acute gastroenteritis

• Risk factors for infant GERD

  • Congenital abnormalities

    • Esophageal disorders

    • Diaphragmatic hernia

    • Neurodevelopmental disorders

  • Prematurity

  • Cystic fibrosis