The nurse is teaching a parent of a 6-month-old infant with gastroesophageal reflux (GER) before discharge. What instructions should the nurse include? (Select all that apply.)

Question

a. Elevate the head of the bed in the crib to a 90-degree angle while the infant is sleeping.
b. Hold the infant in the prone position after a feeding.
c. Discontinue breastfeeding so that a formula and rice cereal mixture can be used.
d. The infant will require the Nissen fundoplication after 1 year of age.
e. Prescribed cimetidine (Tagamet) should be given 30 minutes before feedings.

Answer 1

ANS: B, E
Discharge instructions for an infant with GER should include the prone position (up on the shoulder or across the lap) after a feeding. Use of the prone position while the infant is sleeping is still controversial. The American Academy of Pediatrics recommends the supine position to decrease the risk of sudden infant death syndrome even in infants with GER. Prescribed cimetidine or another proton pump inhibitor should be given 30 minutes before the morning and evening feeding so that peak plasma concentrations occur with mealtime. The head of the bed in the crib does not need to be elevated. The mother may continue to breastfeed or express breast milk to add rice cereal if recommended by the health care provider; thickening breast milk or formula with cereal is not recommended by all practitioners. The Nissen fundoplication is only done on infants with GER in severe cases with complications