# 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? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=542064 > language: ko > subject: Child Health ## 문제 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? The nurse is providing discharge education to parents of a 6-month-old infant diagnosed with GERD who has been experiencing frequent regurgitation and poor weight gain. ## 보기 1. Feed the infant in a supine position to prevent aspiration 2. Keep the infant upright for 30 minutes after feeding **✔ 정답** 3. Increase the feeding volume to compensate for regurgitation 4. Dilute the formula to make it easier to digest **정답: 2** ## 해설 Keeping the infant upright after feeding uses gravity to reduce reflux, which is the key discharge instruction. Other options (supine feeding, increasing volume, diluting formula) are not recommended as they can worsen symptoms. ## 심화 해설 Correct Answer: 2. Keep the infant upright for 30 minutes after feeding Explanation of the Priority Instruction For an infant with gastroesophageal reflux disease (GERD), the cornerstone of nonpharmacologic management is positioning therapy. The instruction to keep the infant upright for 30 minutes after feeding is the priority because it directly utilizes gravity to reduce the passive regurgitation of gastric contents into the esophagus. In infants, the lower esophageal sphincter (LES) is often transiently relaxed, and gastric emptying is slower. Maintaining an upright posture counteracts the pressure gradient from the stomach to the esophagus, decreasing the volume and frequency of reflux episodes. This recommendation is supported by consensus guidelines for the management of GERD in infants, which emphasize postural therapy as a safe, effective, first-line intervention . This simple measure directly addresses the primary symptoms of frequent regurgitation and the consequent poor weight gain by reducing nutrient loss. Analysis of Incorrect Options Option 1: Feed the infant in a supine position to prevent aspiration. This instruction is incorrect and potentially dangerous. Placing an infant with active GERD in a supine position during or immediately after feeding eliminates the beneficial effect of gravity. This position facilitates the passive flow of gastric contents into the esophagus and increases the risk of regurgitation and subsequent aspiration. While the supine position is unequivocally recommended for safe sleep to reduce the risk of sudden infant death syndrome (SIDS), it is not the correct position for feeding management. The clinical approach involves a clear distinction: supine for sleep, but upright and supervised for feeding and the postprandial period. Option 3: Increase the feeding volume to compensate for regurgitation. This instruction is counterproductive. Increasing feeding volume leads to greater gastric distention, which is a primary trigger for transient lower esophageal sphincter relaxations (TLESRs), the predominant mechanism of reflux in infants. A distended stomach increases intragastric pressure, overwhelming the barrier function of the LES and promoting more frequent and voluminous reflux episodes. This approach would likely exacerbate, not compensate for, the symptoms. Management guidelines for infant GERD often suggest smaller, more frequent feedings to avoid gastric distention, directly contradicting this option . Option 4: Dilute the formula to make it easier to digest. This instruction is not a standard or recommended practice for managing GERD. Diluting formula reduces its caloric density, which is particularly harmful for an infant already experiencing poor weight gain, as noted in the scenario. This practice can lead to inadequate nutrition, electrolyte imbalances, and failure to thrive. The focus of dietary management is not on making the formula "easier to digest" by dilution, but rather on using thickened feedings, which increase the viscosity of the stomach contents and have been shown to reduce visible regurgitation . The natural history of GERD in infancy is generally self-limiting, and management aims to support adequate growth and comfort while the condition resolves, making caloric adequacy a critical priority [3,4]. ## 임상 시나리오 ⓘClinical Practice Guide: Infant GERD Discharge Teaching **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. ## 핵심 개념 - **Gastroesophageal Reflux Disease (GERD)** — A chronic digestive condition where stomach contents flow back into the esophagus due to a relaxed lower esophageal sphincter, causing symptoms like regurgitation and poor weight gain in infants. - **Lower Esophageal Sphincter (LES)** — A ring of muscle at the junction of the esophagus and stomach that normally prevents reflux; in infants with GERD, it is often transiently relaxed. - **Postural Therapy** — A nonpharmacologic management strategy using upright positioning to utilize gravity in reducing gastric content reflux into the esophagus. - **Regurgitation** — The effortless passage of gastric contents into the mouth, a common symptom of GERD in infants. ## 같은 주제 문제 - [A nurse is assessing a 6-month-old infant brought to the pediatric clinic by the parents w…](https://mymerci.kr/pages/nclex_q.php?qn_id=542060) - [A nurse is assessing a 6-month-old infant brought to the pediatric clinic by the mother wh…](https://mymerci.kr/pages/nclex_q.php?qn_id=542061) - [A nurse is caring for a 4-month-old infant diagnosed with gastroesophageal reflux disease …](https://mymerci.kr/pages/nclex_q.php?qn_id=542062) - [A nurse is caring for a 6-month-old infant diagnosed with gastroesophageal reflux disease …](https://mymerci.kr/pages/nclex_q.php?qn_id=542063) --- More free questions: [기출문제](https://mymerci.kr/) _학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._