Differential Diagnosis for a 3-Month-Old Boy with Recurrent Episodes of Spitting Up
- Single Most Likely Diagnosis
- Gastroesophageal Reflux (GER): This is the most likely diagnosis given the patient's symptoms of vomiting partially digested breast milk shortly after feeding, without any signs of distress, color change, or respiratory issues. The fact that he remains eager to eat and has normal vital signs further supports this diagnosis, as GER is common in infants and often presents with similar symptoms.
- Other Likely Diagnoses
- Overfeeding or Forceful Feeding: This could lead to spitting up, especially if the infant is being fed too much or too quickly, causing the stomach to overflow.
- Food Allergy or Intolerance: Although less common in breastfed infants, an allergy or intolerance to something in the mother's diet could cause vomiting.
- Pyloric Stenosis: Typically presents with projectile vomiting, but in early stages, it might resemble GER. However, the absence of projectile vomiting and the fact that the emesis is described as partially digested breast milk makes this less likely.
- Do Not Miss Diagnoses
- Pyloric Stenosis: Despite being less likely based on the description, it's crucial to consider due to the potential for severe dehydration and electrolyte imbalance if not treated promptly.
- Intestinal Obstruction: Any sign of vomiting in an infant warrants consideration of an intestinal obstruction, although the clinical presentation here (vomiting after every feed without other symptoms) makes it less likely.
- Inborn Errors of Metabolism: Certain metabolic disorders can present with vomiting after feeding, and while rare, they are critical to diagnose early for proper management.
- Rare Diagnoses
- Gastrointestinal Anomalies (e.g., duodenal atresia, tracheoesophageal fistula): These conditions are less common and often present with more severe symptoms, but should be considered in the differential diagnosis of an infant with persistent vomiting.
- Eosinophilic Esophagitis: An allergic inflammatory condition that could cause vomiting, though it's more commonly associated with older children and adults.
- Congenital Hypertrophic Pyloric Stenosis with Atypical Presentation: While pyloric stenosis is considered above, an atypical presentation without the classic projectile vomiting could make it seem rare or less likely.