OK - I'm stumped (again). I saw an 18 month old girl in the clinic today for followup of this weird head tilt thing she does. As an infant she was worked up for torticollis and after a bunch of testing (to include MRI, UGI, pH probe), it was concluded that she may have Sandifer syndrome and that GER was causing her unusual head tilting episodes. The mother swears that her current meds - Zantac and Cisapride have helped enormously and that her head tilting got better. She experiences no pain with these episodes and is otherwise growing and developing normally. Here's the problem...the mom brings her in for an adjustment of her meds based on her weight gain over the last 6 months. The meds "don't seem to be doing what they used to do". I calculated her dosages based on the last time her meds were refilled and her weight at that time (she was 12 months old). She was on NINE mg/kg/d of Zantac and ONE mg/kg/d of Cisapride (0.25 mg/kg/dose QID). Those doses made my head spin a little. I did refill her meds based on these dosages and her current weight (and also threw in some counselling about the new Cisapride warnings), but it really bothers me the amount of meds she's on. I'm rescheduling her for another UGI and pH probe study. Any comments? Eve H. Switzer, M.D.