1. In the step-wise schematic for the management of pediatric GERD, the use of medication begins from

• Phase 2
• Phase 3
• Phase 1
• Phase 4

2. The mother of a 14-month-old child conveys her concern regarding the frequent episodes of regurgitation her child has been having for the past three months. A thorough physical examination and imaging workup rule out structural etiologies for these complaints, and the child is advised expectant management. She is concerned about the long-term effects of not treating her child’s GERD. Which of the following statements is false in this context?

• There is limited data on the natural history of GERD in infants and children.
• It is still being determined if regurgitation is less frequent in breastfed than in formula-fed infants.
• There is a lack of consensus regarding the non-pharmacological management of regurgitation and physiologic GERD.
• All of the statements are true.

3. A 4-month-old infant girl is brought to the clinic by her mother for complaints of frequent regurgitation of breast milk after feeds and occasional vomiting. On examination, the infant has normal growth parameters and no other abnormalities. Which of the following is the most appropriate recommendation regarding feeding?

• Continue exclusive breastfeeding and provide reassurance
• Recommend thickening feeds with rice cereal
• Switch to a hypoallergenic formula
• Start a proton pump inhibitor medication

4. A 4-week-old exclusively breastfed infant is brought in by his mother for complaints of spitting up and vomiting after more than half of his feeds. He was born full term, and weight gain has been adequate. The mother asks if she should stop breastfeeding him. Which of the following is the most appropriate recommendation regarding breastfeeding?

• Advise the mother to stop all breastfeeding immediately
• Recommend mother supplement feeds with formula
• Reassure the mother and support continued exclusive breastfeeding
• Refer infant for specialist assessment for reflux and allergies

5. A 5-year-old girl with confirmed gastroesophageal reflux disease has had persistent symptoms over the past 4 months despite adhering to lifestyle modifications and an optimised dose of proton pump inhibitor therapy. Which of the following is the best next step for managing her GERD?

• Add a prokinetic medication to her current PPI
• Refer her for antireflux surgery evaluation
• Change to an H2-receptor antagonist from her PPI
• Reassure parents and continue current GERD therapy