6.1.2. Infants With Recurrent Vomiting and Poor Weight Gain A diagnosis of physiologic GER should not be made in an infant with vomiting and poor weight gain. Expert opinion suggests that initial evaluation in an infant with normal physical examination but poor weight gain should include diet history, urinalysis, complete blood count, serum electrolytes, blood urea nitrogen, and serum creatinine. Additional testing should be based on suggestive historical details or results of screening tests. Management may include a 2-week trial of extensively hydrolyzed formula or amino-acid–based formula to exclude cow’s milk allergy, increased caloric density of formula and/or thickened formula, and education as to appropriate daily formula volume required for normal growth. Careful follow-up of interval weight change and caloric intake is essential. If management fails to improve symptoms and weight gain, referral to a pediatric gastroenterologist is recommended.