Too many babies getting reflux meds?

Bonnie - Hmm. Where have you heard this before?

In a commentary published in Journal of Pediatrics, Eric Hassell, MD, a pediatric gastroenterologist, warns that the use of acid-suppressing medications to babies under 1 year old has skyrocketed. One large study in the U.S. found a 16-fold increase in the number of prescriptions for a kid-friendly liquid form of acid-suppressing drugs between 1999 and 2004. Despite this recent spike in prescriptions, Hassall argues that the vast majority of infants don't have gastroesophageal reflux disease (GERD), which is what these drugs are meant to treat. He suggests that a baby's inconsolable crying and spitting up, which are separate symptoms, have become combined into a diagnosis of acid-reflux disease by some pediatricians.

But this spitting up likely isn't "acid reflux" because infants have frequent feedings that tend to buffer stomach acid. Most reflux is physiological. In most cases, it's not the spitting up that should be treated. The real issue is the unexplained crying. Some moms and dads put a lot of pressure on pediatricians to "do something" to help their hard-to-soothe infants. It's sometimes easier and quicker for a doctor to write a prescription instead of taking the time to explain what parents can try in place of drugs. He suspects that both parents and pediatricians are unaware of the extent to which acid-reducing drugs are being overprescribed or of their potential side effects if used long-term.

According to Esther Israel, MD, a pediatric gastroenterologist, "Gastroesophageal reflux is not a disease in infants. It's a normal physiological response that babies often outgrow." She says that before turning to medications, there are a lot of things that can be done from a behavioral perspective. These include soothing-type activities, such as rocking or patting the newborn in a quiet place. Dietary approaches such as switching from a milk protein-containing formula to a soy-based or hydrolyzed one may also make a difference. If a mother is breastfeeding, she can try eliminating milk products from her diet to see how her baby responds. If colic is a concern, infants usually outgrow it in their first three to four months of life.

Cow's Milk Usually to Blame
As the piece above alludes, there are times when infant formula needs to be changed. A study in the October issue of Gut Liver explains that in children who actually do have Gastroesophageal Reflux Disease, cow's milk allergy (CMA) is the major culprit. 81 children with actual GERD were enrolled in the study. All subjects received omeprazole for 4 weeks after the initial evaluation. Empirical elimination of cow's milk from the diet was started for the patients who did not respond to the omeprazole treatment.

Cow's milk was eliminated from the diets of the remaining 27 patients who did not respond to treatment. All signs and symptoms of GERD were resolved in this group after a 4 week elimination of cow's milk from the diet. A diagnosis of CMA was considered in one third of the pediatric cases with signs and symptoms of GERD. This finding shows that CMA can mimic or aggravate all signs and symptoms of severe GERD during infancy.