Gastroesophageal reflux disease (pediatrics) Quiz: Ace Your Exams

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A 7-month-old boy is brought to the clinic due to frequent regurgitation after feedings. The caregiver reports frequent crying during and after feeding, occasional back arching, and reduced feeding volumes over the past two weeks. The infant has recently refused bottle-feeding and has had intermittent non-bloody, nonbilious vomiting. An upper respiratory tract infection occurred three weeks ago. There has not been fever, lethargy, bilious vomiting, hematemesis, or diarrhea. Weight is at the 25^th percentile for age, down from the 45^th percentile two months prior. Vital signs are within normal limits. On examination, the infant appears alert and active with no abnormal findings. Which of the following findings from the history and physical examination should prompt further evaluation?

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Recent upper respiratory tract infection

Bottle refusal for two weeks

Non-bloody, nonbilious vomiting

Change in growth percentile

Crying and back arching during feedings