This may benefit infants who are underweight as a result of GERD. Constant NG feeding may be necessary for the infant with severe reflux and failure to thrive until surgery can be performed. Elevating the head of the bed did not have any effect on GER symptoms in the Cochrane systematic review of 20 research trials (Craig,Hanlon-Dearman,Sinclair,et al,2004). Prone positioning of infants also decreases episodes of GER but is recommended only with extreme caution when the risk of GERD complications exceeds the risk of sudden infant death syndrome (Cavataio and Guandalini, 2005). The American Academy of Pediatrics continues to recommend supine positioning for sleep. (See Chapter 11.)