Infant reflux

Template

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AssessmentChoose one

GrowthChoose one

Red flags presentChoose any

Red flags absentChoose any

FeedingChoose any

Feeding changesChoose any

MedicationChoose one

Safe sleepChoose any

Follow-upChoose one

Follow-up reasonChoose anyJoins the line above

Counseling

Spitting up is very common, peaks around 4 months, and usually goes away by the first birthday. It does not hurt a baby who is gaining weight and content. Recommended supportive care with an emphasis on smaller, more frequent feeds, burping, holding upright after feeds, and always placing your baby to sleep on the back. Return precautions given including green or bloody vomit, forceful vomiting, poor weight gain, refusing feeds, fewer wet diapers, unusual sleepiness, breathing trouble with feeds, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.

CounselingNot in the note with these choices

Most babies with reflux improve as they grow, and feeding changes help many. We will follow weight and comfort closely on this plan. Recommended supportive care with an emphasis on smaller, more frequent feeds, burping, holding upright after feeds, and always placing your baby to sleep on the back. Return precautions given including green or bloody vomit, forceful vomiting, refusing feeds, fewer wet diapers, unusual sleepiness, breathing trouble with feeds, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.

Note when inserted as is

Infant reflux
• Effortless spitting up in a content, growing infant, consistent with physiologic reflux
• Gaining weight well
• No bilious vomiting, bloody vomiting, projectile vomiting, lethargy, fever, blood in the stool, abdominal distention, bulging fontanelle, choking or breathing trouble with feeds, or onset after 6 months
• Discussed holding upright for 20-30 minutes after feeds
• Discussed smaller, more frequent feeds and avoiding overfeeding
• Follow up at the next well child check

Spitting up is very common, peaks around 4 months, and usually goes away by the first birthday. It does not hurt a baby who is gaining weight and content. Recommended supportive care with an emphasis on smaller, more frequent feeds, burping, holding upright after feeds, and always placing your baby to sleep on the back. Return precautions given including green or bloody vomit, forceful vomiting, poor weight gain, refusing feeds, fewer wet diapers, unusual sleepiness, breathing trouble with feeds, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.

What the sources cover

Physiologic GER vs GERD
Red flags
Upright; smaller feeds
Nipple flow; thickening; hydrolyzed formula; maternal dairy-free
Safe sleep, no prone

Return precautions in the template

green or bloody vomitforceful vomitingpoor weight gainrefusing feedsfewer wet diapersunusual sleepinessbreathing trouble with feeds

Sources

AAP clinical report: Lightdale JR, Gremse DA; Section on GI, Hepatology, and Nutrition. Gastroesophageal Reflux: Management Guidance for the Pediatrician. Pediatrics…
The Cribsiders #75: GERD
The Cribsiders #105: rapid review

Few formal guidelines cover this topic, so the template also leans on expert opinion.