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Table 2

Diagnostic criteria for IIMSO and GERD in the context of the patient presented (15)

CharacteristicsIISMOGERDPatient Presentation/Complaints
Crying PatternsExcessive crying any time of the day, generally increasing in the eveningIrritable and excessive crying within a few minutes of feeding possibly due to heartburn and acid reflux/abdominal pain.The patient exhibited excessive crying and irritability; particularly following feeding. The patient had abdominal pain as demonstrated by abdominal muscle contractions
Postures, movements, positional preferencesProlonged antalgic posture for the sake of comfort; asymmetric movements/activities; unilateral spinal hypertonicity; tactile defensiveness; spinal sensitivity in specific areasPrefers to sit upright; dislikes the prone position and demonstrates mild arching related to feeding.Demonstrated the arching posture in addition to exhibiting spinal sensitivity in certain areas. Tactile sensitivity to stimulation on the abdomen
Eating BehaviorsFeeding disturbance which may be related to suck dysfunctionFrequent, recurrent vomiting, regurgitation; re-swallowing; may bite lip, show acid burns on lip; retching, choking, frequent cough; tongue thrusting nipple or pacifier; occasional diaphoresis while feedingFrequent recurrent vomiting and regurgitation in addition to feeding disturbances. The patient demonstrated suck dysfunction.
Digestive DisturbanceNone or UnrelatedOccasional heme-positive stools or emesis; occasional failure to thrivePatient has failure to to thrive
Other signs, Symptoms and Timing of DisorderRestless sleep or may refuse to sleep supine; affective disorder common; condition does not tend to improve over time, but may change as infant gains more strength and control, distress may change to “control” behaviors, such as head banging.Persistence after 12 weeks, resolves by 1 year; diagnosed most often with history. Tests are barium swallow, pH probe, upper GI endoscopy or gastric emptying studies (usually unnecessary). Rarely responds to medication under 2 years of ageRestless sleep along with non-responsiveness to medication.