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GORD – PPI trial — RACP Paediatrics MCQ

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ModerateGIGORD – PPI trialRACP Paediatrics

A 4-month-old has frequent regurgitation with back arching (Sandifer posturing), feed refusal, weight faltering, and irritability during feeds. Positioned upright and tried thickened feeds without improvement. What is the most appropriate next pharmacological step?

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Correct answer: E — Omeprazole

GORD (as opposed to GOR) with weight faltering, pain behaviours, and feed refusal warrants a trial of acid suppression. A PPI (omeprazole) is the most effective acid suppressant and is first-line pharmacological therapy. A 4-week trial is recommended. If symptoms resolve, attempt weaning after 4-8 weeks. Ranitidine is no longer available in Australia (NDMA contamination withdrawal).

Reference: RCH Melbourne – 2023 – GOR CPG; RACP Paediatric Curriculum – GI