<prompt> Which of the following is the earliest indicator of pathological gastroesophageal reflux in infants GERD -Respiratory SymptomsPostprandial RegurgitationUpper GI BleedStricture Esophagus  <response>: Ans is a i.e., Respiratory Symptoms Recurrent Respiratory Symptoms Wheezing, stridor, chronic cough apnea, aspiration are the earliest indicator of Pathological Reflux GERD amongst the options provided. The most frequent complications of Gastroesophageal Reflux disease pathological Reflux in infants are failure to thrive and recurrent pulmonary symptoms -- Bailey Johnsons Head Neck Surgery Otolaryngology 4th1108. Gastroesophagial reflux disease GERD in infants o Gastroesophagial reflux refers to the passage of gastric contents into the esophagus or orpharynx. o GERD is one of the most frequent problems among infants. o Reflux in infants usually develops when they are between two to four weeks old. Within 6-9 months, the acid reflux stas subsiding and it resolves in most of the cases. Clinical features o Post-prandial regurgitation is the most common and probably the earliest syptom of GERD. However, the presence of postprandial regurgitation does not suggest pathological nature of reflux process as regurgitation is also seen in normal infants. optiopn b is not correct o Pathological reflux or GERD is said to be present when frequency andor duration of reflux episodes results in troublesome symptoms and complications esophagitis or pulmonary. Symptoms of GERD are failure to thrive, poor weight gain, feeding refusal, recurrent vomiting, generalized irritability, respiratory symptoms and archingbradycardia. Treatment o Conservative measures may be adequate to treat uncomplicated, mild GERD in infants, however, when therapy is necessary for 2 weeks or longer, proton-pump inhibitors are the treatment of choice in children. Remember Most common and earliest symptom of GERD in infant -- Regurgitation. For diagnosing pathological GERD regurgitation alone is not enough as there is physiological reflux regurgitationin normal infants. Regurgitation plus one or more troublesome symptoms Respiratory symptoms, failure to thrive, poor weight gain, etc are required to indicate pathological GERD. 