Which management is not recommended as first-line for gastroesophageal reflux disease in infants?

Which management is not recommended as first-line for gastroesophageal reflux disease in infants?

• A. Trial of extensively hydrolyzed formula
• B. Proton pump inhibitor therapy
• C. Esophageal pH monitoring
• D. Reassurance

Answer: (B)

In infants, most reflux is physiological and resolves with age, so the initial approach focuses on reassurance and non-drug strategies rather than medications. A trial of extensively hydrolyzed formula is used when there’s suspicion of cow’s milk protein allergy and can help some infants with reflux symptoms. Thickened feeds can also reduce visible regurgitation in some babies. Proton pump inhibitors are not recommended as first-line because reducing stomach acid doesn’t reliably improve typical reflux symptoms in otherwise healthy infants, and these medicines carry safety concerns—higher risk of infections and potential nutrient absorption issues with long-term use. Esophageal pH monitoring is a diagnostic test used in select cases to confirm GERD or evaluate treatment failure, not a first-step management approach. So the best initial plan centers on reassurance and non-pharmacologic or targeted dietary measures rather than starting acid-suppressing therapy.

In infants, most reflux is physiological and resolves with age, so the initial approach focuses on reassurance and non-drug strategies rather than medications. A trial of extensively hydrolyzed formula is used when there’s suspicion of cow’s milk protein allergy and can help some infants with reflux symptoms. Thickened feeds can also reduce visible regurgitation in some babies. Proton pump inhibitors are not recommended as first-line because reducing stomach acid doesn’t reliably improve typical reflux symptoms in otherwise healthy infants, and these medicines carry safety concerns—higher risk of infections and potential nutrient absorption issues with long-term use. Esophageal pH monitoring is a diagnostic test used in select cases to confirm GERD or evaluate treatment failure, not a first-step management approach. So the best initial plan centers on reassurance and non-pharmacologic or targeted dietary measures rather than starting acid-suppressing therapy.