Differential Diagnosis
- Single most likely diagnosis
- A) Gastroesophageal reflux disease: This is the most likely diagnosis given the symptoms of frequent spitting up after eating and a drop in weight percentile, which suggests that the child is not retaining enough nutrients. The absence of other symptoms such as diarrhea, fever, or abdominal pain also points towards gastroesophageal reflux disease (GERD) as the primary cause.
- Other Likely diagnoses
- E) Pyloric stenosis: Although less common than GERD, pyloric stenosis could also explain the vomiting and weight loss. However, it typically presents with more forceful vomiting and is often accompanied by other signs such as a palpable "olive" mass in the upper abdomen, which is not mentioned in the scenario.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- B) Inflammatory bowel disease: Although rare in infants, inflammatory bowel disease (IBD) can present with nonspecific symptoms such as weight loss and vomiting. Missing this diagnosis could lead to severe complications, so it's crucial to consider it, even if it's less likely.
- C) Necrotizing enterocolitis: This condition is more common in premature infants but can occur in term infants as well. It's a medical emergency that requires prompt diagnosis and treatment. The absence of diarrhea or fever does not rule out this condition entirely, making it a "do not miss" diagnosis.
- Rare diagnoses
- D) Pancreatitis: Pancreatitis is extremely rare in infants and would typically present with severe abdominal pain, which is not mentioned in the scenario. While it's unlikely, any condition causing severe abdominal symptoms should prompt consideration of pancreatitis due to its potential severity.