Question

The parents of a 3-month-old reports that the infant arches and gages while feeding and spits up undigested formula frequently. The infant's weight gain has dropped to the 5th percentile from the 12th percentile. What is the best course of treatment for this infant?

1) begin a trial of extensively hydrolyzed protein formula for 2-4 weeks
2) initiate an empiric trial of acid suppression with a proton pump inhibitor
3) perform an esophageal pH monitoring to determine the degree of reflux
4) reassure the parent that these symptoms will likely resolve by 12-24 months

Answer 1

The best initial treatment for the symptomatic infant is likely an empiric trial of acid suppression with a proton pump inhibitor to reduce acid reflux symptoms and improve feeding tolerance. Further evaluation should be considered if symptoms persist.

Step-by-step explanation:

The infant showing symptoms of arching and gagging while feeding, frequent spit-up of undigested formula, and poor weight gain may be exhibiting signs of gastroesophageal reflux disease (GERD). Extensively hydrolyzed protein formula may be beneficial if a milk protein allergy is contributing to the symptoms. However, the best initial course of treatment in this case, considering the significant symptoms and impact on weight gain, would likely be to initiate an empiric trial of acid suppression with a proton pump inhibitor (PPI). This can help to reduce the acid reflux symptoms and improve feeding tolerance. It would be appropriate to monitor the infant's response to the treatment and consider further evaluation such as esophageal pH monitoring if symptoms persist. Reassurance that the symptoms will resolve is not appropriate considering the infant's weight gain has dropped significantly.