When an infant with GORD does not improve with feeding assessment, what is the next step in management?

In cases where an infant with gastro-oesophageal reflux disease (GORD) does not show improvement with feeding assessment, the next step in management typically involves pharmacological intervention. Offering proton pump inhibitors or H2 receptor antagonists is appropriate because these medications can significantly reduce gastric acid production, thereby alleviating symptoms associated with GORD, such as irritability, poor feeding, and failure to thrive.

Proton pump inhibitors are particularly effective because they provide a more sustained reduction in acid secretion compared to H2 receptor antagonists, and they can help heal any esophagitis if present. The decision to initiate these medications hinges on the ongoing symptoms despite optimizing feeding practices, allowing clinicians to address the likelihood of acid-related damage to the esophagus that may be contributing to the infant's distress.

Other management strategies, such as increasing feeding frequency or switching to exclusive breastfeeding, may not effectively address the underlying mechanism of GORD and could potentially prolong discomfort for the infant. Consulting a specialty clinic might be necessary later if the infant continues to have symptoms despite medication, but initial pharmacological treatment is a well-accepted and evidence-based approach in managing GORD in this scenario.