A 9-month-old infant with gastroesophageal reflux disease (GERD) is being discharged home. Which instruction should the nurse prioritize when teaching the parents about feeding management?

Priority Instruction: Maintain infant in an upright position (at least 30-45 degrees) for 20-30 minutes after every feeding. This uses gravity to reduce passive reflux of gastric contents.

Feeding Technique: Provide smaller, more frequent feedings to avoid gastric distension. Burp the infant gently and frequently during feeds to release swallowed air. Never prop the bottle or feed in a supine position.

Sleep Safety: The infant must always be placed supine for sleep on a firm, flat surface, even with a GERD diagnosis. Elevating the head of the crib is not recommended due to SIDS risk unless specifically ordered and monitored.

Monitoring & Follow-up: Track wet diapers, weight gain, and frequency/volume of regurgitation. Report signs of complications: forceful vomiting, hematemesis, respiratory distress, or persistent irritability.

Formula Management: Do not dilute formula. If thickened feeds are recommended by the provider, use commercial thickeners or anti-regurgitation formula. Ensure the nipple hole size is appropriate for the thickness.