A nurse is caring for an infant who has gastroesophageal reflux (GER). Which of the following actions should the nurse take to prevent regurgitation? (Select all that apply.)

Choice A rationale Gastroesophageal reflux (GER) involves the retrograde flow of gastric contents into the esophagus. By thickening the infant's formula with a substance like cereal, the viscosity of the feeding is increased. This higher viscosity makes it more difficult for the stomach contents to flow back up the esophagus, thereby reducing the frequency and severity of regurgitation episodes. The increased density helps the food stay in the stomach. Choice B rationale While citrus juices are known to be acidic and may exacerbate symptoms of GER in some individuals by irritating the esophageal mucosa, avoiding them is a management strategy for symptom control rather than a primary action to physically prevent the act of regurgitation itself. The mechanism of regurgitation is mechanical, related to the lower esophageal sphincter, not solely to the pH of the consumed liquid. This choice does not directly prevent the physical reflux. Choice C rationale Elevating the infant's head after meals leverages gravity to help keep gastric contents in the stomach and away from the esophagus. A head elevation of at least 30 degrees is often recommended to reduce the pressure on the lower esophageal sphincter (LES), thus decreasing the likelihood of stomach acid and food flowing backward, which is the physiological basis of regurgitation. Choice D rationale Placing an infant on a soft pillow while sleeping poses a significant risk of sudden infant death syndrome (SIDS) due to potential suffocation. Soft bedding can obstruct the infant's airway. The American Academy of Pediatrics recommends that infants sleep on a firm surface without any pillows, blankets, or soft toys to minimize these risks, making this a dangerous and contraindicated practice for an infant. Choice E rationale Antiemetics are medications used to treat nausea and vomiting by acting on chemoreceptor trigger zones in the brain or other peripheral receptors. They do not prevent the mechanical process of regurgitation in infants with GER. Furthermore, these medications are generally not recommended for routine use in infants with uncomplicated GER due to potential adverse effects and the self-limiting nature of the condition.