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If you believe your baby is suffering from infant reflux and are
having a difficult time getting your doctor to listen to you or confirm
that diagnosis and help with medication, print and fill out the
following list of symptoms for your next visit. Remember you are
your child's best advocate, the child's doctor will rely on you for an
accurate and thorough description of your child's symptoms.
Remember, be assertive, but not aggressive.
This tool can also be used to determine success or failure of
treatment methods as they are introduced, just date it before hand, mark
the treatment and date started and after a week or two compare the
results with the pre-treatment form.
Take this, along with the
infant reflux impact survey with you to your next doctor's
appointment.
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Symptoms
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Frequently
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Occasionally
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Never
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Excessive crying or colic
like behavior
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Irritability or pain
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Poor sleep and frequent
waking
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Neck and back arching, particularly during
and after eating
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Frequent spitting and / or
throwing up
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Wet burps and / or frequent
hiccups
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Ear, sinus or respiratory
infections
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Refusing food
or accepting only a few bites despite being
hungry
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Food/oral aversions
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Swallowing problems,
gagging, choking
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Chronic hoarse voice
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Frequent red, sore throat without infection
present
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Apnea
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Gagging themselves with
their fingers or fist (sign of esophagitis)
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Poor weight gain, weight
loss, failure to thrive
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Respiratory problems—pneumonia, bronchitis,
wheezing, asthma, night-time cough,
aspiration
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Erosion of dental enamel
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Neck arching (Sandifer's
Syndrome)
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Bad breath
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I believe my child is in
pain
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