Acid-suppressing drugs to treat spit-up?

GERD in infants

(RxWiki News) Spitting up, crying, and irritability are all common behaviors for babies, right? So why are infants being prescribed acid-suppressing drugs to treat these symptoms?

That's what Dr. Eric Hassall, MD, wants to know. In a commentary for The Journal of Pediatrics, he writes that skyrocketing use of acid-suppressing drugs has no justification in medical science, and that otherwise healthy babies are being over-diagnosed with gastroesophageal reflux disease (GERD).

"Second opinions may help diagnose GERD."

Dr. Hassell cites a study demonstrating that in the span of six years, between 1999 and 2004, there was about a seven-fold increase in prescriptions of acid-suppressing drugs for infants under the age of one. One of these drugs had a sixteen fold increase in use during this period. Dr. Hassell writes that these statistics are symptomatic of over-prescription, and that these drugs are not being used to treat real conditions.

Most of what is considered “reflux” in infants is normal behavior, Dr. Hassell writes. Spitting up is a physiologic reflux rather than acid reflux – babies spit up because they need frequent feedings, but can't digest very well. This spit-up is rarely acidic. Unexplained crying, or colic, often warrants a prescription for acid-suppressing drugs as well, but studies have shown that these drugs have no better effect than placebo.

Dr. Hassell blames this phenomena of over-prescription on pediatrician's environment and culture. He wrote, “With increasingly less time to evaluate patients, rather than take on the more time-consuming history, discussion, and approaches, including behavioral and dietary, that are required around the evaluation of unexplained crying, and not without parental pressure to ‘‘do something,’’ doctors have taken to a quicker approach: prescribing.”

Most of these conditions resolve themselves with time, Dr. Hassell says. Taking medications for normal behavior can lead to increased risks for infections like pneumonia and gastroenteritis, and cause nutrient deficiencies.

Dr. Hassell encourages pediatricians to recommend non-medicated solutions to their patients, such as changes in maternal diet for breastfeeding moms or hypoallergenic formulas for bottle-fed children. If these approaches fail, an acid-suppressing drug should be tried for a limited time, but not used as if it is treating a chronic condition. Some children do suffer from GERD at an early age, and drugs are appropriate in those cases.

Dr. Eric Hassell's commentary was published in the Journal of Pediatrics on October 20, 2011.

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Review Date: 
October 22, 2011