Which finding is most suggestive of gastroesophageal reflux in a 2-month-old with frequent vomiting?

Which finding is most suggestive of gastroesophageal reflux in a 2-month-old with frequent vomiting?

• A. He drinks 7-8 oz every 3-4 hrs
• B. He gained 5 oz this month
• C. He has a slight wheeze today
• D. He eats hungrily after vomiting

Answer: (A)

A large-volume, regular feeding pattern in a 2-month-old with frequent vomiting points most directly to reflux. When the stomach is distended by big feeds (7–8 oz every 3–4 hours), the lower esophageal sphincter is more likely to relax or fail to contain the contents, leading to regurgitation and vomiting after feeds. This pattern reflects the mechanical aspect of reflux during infancy and is more characteristic than isolated airway symptoms, feeding gain alone, or hunger after vomiting, which can occur with other issues. In contrast, a mild wheeze can be caused by infections or reactive airways and is less specific for GER. Poor weight gain would be concerning but is a result rather than a defining feeding pattern of reflux.

A large-volume, regular feeding pattern in a 2-month-old with frequent vomiting points most directly to reflux. When the stomach is distended by big feeds (7–8 oz every 3–4 hours), the lower esophageal sphincter is more likely to relax or fail to contain the contents, leading to regurgitation and vomiting after feeds. This pattern reflects the mechanical aspect of reflux during infancy and is more characteristic than isolated airway symptoms, feeding gain alone, or hunger after vomiting, which can occur with other issues. In contrast, a mild wheeze can be caused by infections or reactive airways and is less specific for GER. Poor weight gain would be concerning but is a result rather than a defining feeding pattern of reflux.