An infant with GERD presents with frequent post-feed vomiting, irritability, and poor weight gain. Which nursing interventions are appropriate? Select all that apply.

A. Place infant in supine position immediately after feeding: Supine positioning right after feeding can worsen reflux symptoms and increase the risk of aspiration. While infants should sleep supine to reduce SIDS risk, after feeds they should be kept upright to minimize regurgitation. B. Encourage large, less frequent feedings: Large volume feedings increase gastric distention and promote reflux. Smaller, more frequent feedings are preferred to reduce pressure on the lower esophageal sphincter and decrease episodes of vomiting. C. Keep infant upright for 20–30 minutes after feeds: Maintaining an upright position after feeding uses gravity to limit reflux and reduce regurgitation episodes. This intervention helps decrease irritability and supports better feeding tolerance. D. Monitor weight closely: Infants with GERD are at risk for poor growth and failure to thrive due to calorie loss from frequent vomiting. Regular weight monitoring ensures nutritional status is maintained and identifies the need for adjustments in care. E. Thicken feeds with rice cereal: Thickening formula with rice cereal can reduce the frequency of regurgitation by making feeds heavier and less likely to reflux. This intervention is often recommended under healthcare provider guidance to promote weight gain and reduce symptoms.