Gastroesophageal reflux disease (pediatrics) Quiz: Ace Your Exams

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A 6-month-old boy is brought to clinic due to frequent regurgitation and irritability during and after feedings for one month. The infant arches his back during feedings, cries excessively, and often refuses to finish formula bottles. Feeding occurs every 4 hours, with approximately 4 ounces consumed per feed. There is no bilious or bloody vomiting. The parents report no fever, diarrhea, lethargy, or respiratory symptoms. Weight is at the 45^th percentile for age, and growth parameters are consistent with previous visits. Vital signs are within normal limits. The infant appears alert and well-hydrated. The abdomen is soft and non-tender, with no hepatosplenomegaly or palpable masses. Which of the following is the most appropriate initial step in management?

Elimination tool

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Esophageal pH monitoring

Thickened and smaller, frequent feedings

Elimination of cow’s milk protein from the diet

Proton pump inhibitor (PPI) therapy

Pediatric gastroenterologist referral