Differential Diagnosis for a 2-Month-Old with Frequent Spit Up and Trouble Breast Feeding

• Single Most Likely Diagnosis
  • Gastroesophageal Reflux Disease (GERD): This condition is common in infants and can cause frequent spit-up and discomfort, leading to feeding difficulties. The symptoms presented are classic for GERD, making it the most likely diagnosis.
• Other Likely Diagnoses
  • Oral Motor Dysfunction: Issues with the coordination of sucking, swallowing, and breathing can lead to trouble with breastfeeding and may cause spit-up due to ineffective feeding.
  • Tongue-Tie or Lip Tie: These anatomical issues can hinder proper latching and sucking, leading to feeding difficulties and potential spit-up.
  • Overactive Letdown or Oversupply: An overactive letdown reflex or an oversupply of milk can cause the baby to gag or spit up, especially if the baby is having trouble managing the flow of milk.
• Do Not Miss Diagnoses
  • Pyloric Stenosis: Although less common, pyloric stenosis is a condition that can cause projectile vomiting and must be considered, especially if the spit-up is forceful and if the infant shows signs of dehydration or failure to thrive.
  • Esophageal Atresia or Tracheoesophageal Fistula: These congenital anomalies can cause severe feeding difficulties and are critical to diagnose early for appropriate surgical intervention.
  • Cow’s Milk Protein Allergy or Intolerance: In breastfed infants, an allergy or intolerance to cow’s milk proteins in the mother’s diet can cause symptoms similar to GERD, including spit-up and fussiness.
• Rare Diagnoses
  • Eosinophilic Esophagitis: An inflammatory condition of the esophagus that can cause feeding difficulties and spit-up, though it is less common in infants.
  • Gastrointestinal Obstruction: Conditions such as intestinal malrotation or Hirschsprung’s disease can cause vomiting and feeding issues, though they are rare and typically present with other significant symptoms.