TABLE 91.6 SIGNS AND SYMPTOMS OF GERD BY AGE Infants 1 yr of age Recurrent vomiting/regurgitation Abdominal pain Recurrent regurgitation without vomiting Recurrent vomiting Poor weight gain Chest pain Irritability Back arching Heartburn Chronic cough Sleep interruption Sleep interruption Cough Burping Choking/gagging Food refusal Food refusal Dystonic posturing (Sandifer syndrome) Apparent life-threatening event Adapted from Lightdale JR, Gremse DA Gastroesophageal reflux: management guidance for the pediatrician Pediatrics 2013;131(5): e1684–e1695 TABLE 91.7 RED FLAG SIGNS AND SYMPTOMS IN CHILD WITH VOMITING Significant weight loss Fever Bilious, nocturnal or persistent emesis Lethargy GI bleeding (hematemesis, melena, bloody diarrhea) Hepatosplenomegaly Forceful vomiting Macro- or microcephaly, excessive increase in head circumference or bulging fontanelle Failure to thrive, weight loss Seizure Constipation/diarrhea Hyper- or hypotonia, Abnormal psychomotor development Recurrent pneumonia Onset