Differential Diagnosis for Spitting Up at Home and Night

• Single most likely diagnosis
  • Gastroesophageal reflux disease (GERD): This condition is characterized by the backflow of stomach acid into the esophagus, which can cause spitting up, especially after feeding and when lying down, such as at night. The symptoms not being present in the morning or at lunch could be due to the natural fluctuation of symptoms or the position of the body during these times.
• Other Likely diagnoses
  • Overfeeding or feeding too quickly: This can lead to spitting up, especially if the baby is not burped properly or if the feeding schedule is not well-established. The fact that it happens at home and night might suggest a pattern related to feeding practices.
  • Food allergy or intolerance: Though less common, an allergy or intolerance to a component of the formula or breast milk (if the mother consumes certain foods) could cause spitting up. The variability in symptoms could be related to the amount or type of food consumed.
  • Positional issues: The way the baby is positioned after feeding, especially if they are laid down flat immediately after, can exacerbate spitting up.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Pyloric stenosis: A condition where the pylorus (the passage between the stomach and small intestine) thickens, blocking food from entering the intestine. It typically presents with projectile vomiting after feeding but could initially be mistaken for simple spitting up. It's crucial to diagnose early as it requires surgical intervention.
  • Esophageal stricture or obstruction: Though rare, any obstruction in the esophagus could lead to difficulty feeding and spitting up. This would be an emergency if suspected.
• Rare diagnoses
  • Eosinophilic esophagitis: An immune system disorder that causes eosinophils to build up in the esophagus, leading to inflammation and difficulty swallowing, which might present with spitting up among other symptoms.
  • Congenital anomalies of the gastrointestinal tract: Conditions such as tracheoesophageal fistula or esophageal atresia, which are present at birth and can cause feeding difficulties and spitting up. These are usually identified early in life but could be considered in the differential if not previously diagnosed.