In the infant with recurrent vomiting, a thorough history and physical examination are often sufficient to establish a diagnosis of uncomplicated gastroesophageal reflux disease (GERD), labeling the infant as "the happy spitter." Diagnostic evaluation is indicated if there are signs of poor weight gain, GI obstruction, excessive crying and irritability, disturbed sleep, or feeding or respiratory problems suggesting suspected asthma or recurrent pneumonia. In the infant with uncomplicated GERD, parental education, reassurance, and anticipatory guidance are recommended; no specific intervention is necessary because the process is usually self-limited. Thickened formula and a trial of a hypoallergenic formula are the best treatment options. A trial of time-limited acid-suppression therapy, usually with histamine-2 receptor antagonists (H2RAs), is useful in determining if GERD is causing vomiting and regurgitation. If symptoms worsen or do not improve by 18 to 24 months of age, reevaluation for complications of GERD is recommended, including an upper GI series (barium swallow study) and consultation with a pediatric gastroenterologist. In otherwise normal children who have recurrent vomiting or regurgitation after age 2 years, management options include an upper GI series, upper endoscopy with biopsy, and antisecretory therapy (Rudolph, 2001).
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