Differential Diagnosis for a 53-Day-Old Infant with Vomiting after Feeding

Single Most Likely Diagnosis

• Gastroesophageal Reflux Disease (GERD): This condition is common in infants and can cause non-bilious vomiting after feeding. The presence of thrush (oral candidiasis) could be a secondary infection due to the altered oral environment from frequent vomiting.

Other Likely Diagnoses

• Oral Thrush: While mentioned as a finding, oral thrush itself can cause discomfort and potentially lead to feeding difficulties or refusal, which might be mistaken for vomiting.
• Overfeeding or Incorrect Feeding Technique: Overfeeding or using an inappropriate feeding technique can lead to vomiting in infants.
• Lactose Intolerance or Milk Protein Allergy: Though less common in this age group, these conditions can cause vomiting after feeding, especially if the infant is formula-fed or if the mother consumes dairy products while breastfeeding.

Do Not Miss Diagnoses

• Pyloric Stenosis: Although typically presents with bilious vomiting, it's crucial not to miss this diagnosis as it requires surgical intervention. Early cases might not always present classically.
• Infectious Causes (e.g., Urinary Tract Infections, Sepsis): Infections can cause non-specific symptoms in infants, including vomiting. It's essential to consider these, especially if the infant shows other signs of illness.
• Congenital Anomalies (e.g., Esophageal Atresia, Tracheoesophageal Fistula): Though these conditions are usually diagnosed shortly after birth, some cases might not be immediately apparent.

Rare Diagnoses

• Metabolic Disorders: Certain metabolic disorders can present with vomiting in the neonatal period. These are rare but critical to diagnose early for proper management.
• Food Protein-Induced Enterocolitis Syndrome (FPIES): A rare condition that can cause vomiting, typically after feeding, and can be severe.

Management

Management will depend on the diagnosis but may include:

• For GERD: Lifestyle modifications (e.g., feeding smaller, more frequent meals, elevating the head of the bed), and possibly medication (e.g., ranitidine).
• For Oral Thrush: Antifungal medication (e.g., nystatin).
• For Overfeeding or Incorrect Feeding Technique: Education on proper feeding techniques and amounts.
• For Lactose Intolerance or Milk Protein Allergy: Dietary changes (e.g., switching to a hypoallergenic formula).
• For other conditions, management will be specific to the diagnosis (e.g., surgical intervention for pyloric stenosis, antibiotics for infections).