What is the initial action to take when a baby with GORD managed with PPIs or H2RAs is not improving?

When managing a baby with Gastroesophageal Reflux Disease (GORD) who is already on proton pump inhibitors (PPIs) or H2 receptor antagonists (H2RAs) but is not showing improvement, the initial action of considering enteral feeding becomes relevant. This approach is based on the understanding that certain dietary modifications may provide relief for infants suffering from GORD.

In cases where pharmacological interventions have not led to improvement, it is essential to assess the feeding practices. Enteral feeding adjustments, such as using thicker formulas or feeding smaller amounts more frequently, can help reduce reflux symptoms and improve overall comfort and nutrition in infants.

While other options like increasing medication dosage or switching to a different medication class could potentially be explored later, they are not the immediate steps to address the lack of response to current treatment, as they focus more on medication management rather than addressing possible underlying feeding issues.

Thus, considering enteral feeding adjustments is a practical and non-invasive immediate step that may significantly benefit a baby suffering from GORD, particularly when medical management alone has not been sufficient.