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Acid reflux drugs for babies may be driven by 'GERD mania'

Kathleen Blanchard's picture
Acid reflux drugs used too often in infants

Drugs for heartburn overprescribed when babies spit up and cry

Acid suppressing drugs can help upset parents. But a commentary published in the Journal of Pediatrics suggests giving infants acid suppressing medications, known as proton pump inhibitors, seems to be mostly fueled by “GERD mania”.

Dr. Eric Hassall, a professor of pediatrics at the University of British Columbia and a member of the division of gastroenterology at BC Children's Hospital, warns acid suppressing drugs in infants – under age one – are over prescribed; mostly by physicians who succumb to requests from parents.

He says there is no medical evidence to show heartburn drugs are effective, except for children age 1 to 17 with proven GERD (gastroesophageal reflux disease) – yet their use has increased dramatically in the last decade.

He points out studies have shown the GERD drugs are no more effective than placebo.

Hassall says the medications are popularized by drug advertisements and misinformation on the Internet, which suggest babies who spit up and cry should take heartburn medicines.

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But, Hassall says, babies don’t often experience GERD because frequent feedings act like a buffer against acidic stomach contents.

He explains, “Parents, concerned by their infant's symptoms of apparent suffering, take their concern to doctors, who very frequently comply and prescribe acid-suppressing medications for symptoms and signs that in most cases are not GERD. GERD-mania is in full cry, so to speak."

He says some babies start to cry and just can’t calm themselves. They may just be getting used to “gassiness”, a new world and bodily sensations. Hassall says treating infants with acid reflux drugs is “medicalizing normality”.

Rather than giving your infant acid reducing drugs, Hassall says parents should look for the cause of frequent bouts of spitting up and crying. Clinicians should opt for nonpharmacological approaches such as switching to hypoallergenic formula and changes in maternal diet when moms are breastfeeding.

If the above changes don’t work, and there is strong suspicion of GERD, his recommendation is to use drugs that block histamine release, known as H2 blockers like famotidine (Pepcid) and ranitidine (Zantac), but only for two weeks. Treatment could be extended, if needed or a PPI can be tried once a day, depending on response.

“In most cases, it is not the spitting up that should be treated. The real issue is the unexplained crying, which causes real and considerable distress and concern for parents”, says Hassall. He adds you can’t blame parent for worrying, however, and stresses clinicians should empathize, follow up and educate parents about normal infant behavior.

The commentary, published in the Journal of Pediatrics, suggests ‘GERD mania’ from parents drives overprescribing of acid reflux drugs in infants. But in reality, few babies even need to be taking the medications that suppress stomach acid.

Image credit: Morguefile