“A 4-month-old female is brought to your office by her parents because she spits up after most feedings. She is their first child and was born at term with no prenatal or postnatal complications. She is formula fed. A review of her growth chart shows normal growth. Her physical examination and vital signs are normal as well. Which one of the following would be most appropriate at this point? Answer: Reassurance only
Gastroesophageal reflux is very common in infants. Reflux in infants peaks at 4 months of age, and two-thirds of infants regurgitate at least once a day at this age. The incidence declines dramatically in the next few months, and by 1 year of age less than 5% of infants regurgitate on a daily basis. If the infant is healthy and growing normally, reassurance is appropriate (SOR C). Conservative measures are recommended if the reflux causes distress (SOR C). Such measures include placing the infant on her side or prone while awake to reduce reflux. However, infants should not be placed prone while sleeping, to prevent SIDS. Appropriate conservative measures also include smaller, more frequent feedings, the addition of thickening agents such as rice cereal to formula, and changing to amino acid formulas if infants are allergic to cow’s milk protein. If conservative measures and time do not alleviate the symptoms, a 4-week trial of H2-blockers or proton pump inhibitors can be tried. The American Academy of Pediatrics and the Society of Hospital Medicine (Pediatric) recommend not routinely treating reflux with medication. Imaging, such as esophagogastroduodenoscopy, is not routinely used in the initial workup of reflux in infants. It is reserved for recalcitrant cases, atypical symptoms, or complications (SOR C).” ABFM
Reference
Am Fam Physician. 2015 Oct 15;92(8):705-717. http://www.aafp.org/afp/2015/1015/p705.html