Too Many Babies Receive Acid Reflux Meds, Says Pediatrician

Nov. 11, 2011— -- Babies will be babies, said Dr. Eric Hassall, staff pediatric gastroenterologist at Sutter Pacific Medical Foundation in San Francisco.

They cry and spit up. Hassall strongly reiterates that point in a commentary he published in the Journal of Pediatrics in which he expresses worry over the drastic rise in the number of parents giving acid reflux medication to their infants in an attempt to keep them from spitting up.

Hassall found that the use of proton pump inhibitors, a group of drugs meant to reduce gastric acid production, grew exponentially for babies less than a year old over the past decade.

He blames advertising and pharmaceutical company promotion for the increase, as well as misleading misdiagnoses. One study that analyzed data of more than 1 million babies found a sevenfold increase in the amount of acid reflux medication prescribed to infants between 1999 and 2004. About .5 percent of the infants studied in the research received the medication within the first year of their lives, and half of those babies received the drugs before they were 4 months old.

While it is difficult for parents to watch their child scream and spit up from perceived pain, Hassall emphasized that spitting up and crying in an otherwise healthy baby is normal. Despite this, babies are increasingly getting misdiagnosed with gastroesophageal reflux disease, or GERD, a condition in which food and liquid in the stomach leak backward into the esophagus.

The FDA has not approved these drugs for children under a year old because no studies have found them effective in that population.

"In the absence of better information and physician guidance, and fed by advertising and misinformation on the Internet, parent blogs have increasingly promoted the '''my-baby-has-acid-reflux-and-needs-drugs' concept," Hassall said in a statement. "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."

In certain circumstances, there may be an indication that medication is needed, said Keith Ayoob, associate professor of pediatrics at Albert Einstein College of Medicine.

"But when you see a sevenfold increase in PPI prescriptions, you worry that the condition is being overdiagnosed, or if reflux is sort of a garbage-can diagnosis used anytime a child is crying and there's no obvious cause," said Ayoob. "You also get concerned that, if the medication does seem to produce relief, that reflux is truly the cause, or if it's perhaps hiding something else."

Gastric acid is an early line of defense against bacteria, said Hassall. By prescribing acid reflux medication, the babies are at higher risk for pneumonia and gastroenteritis.

Before turning to medication, Hassall encouraged parents to try a few nonmedications first. Oftentimes, severe unexplained crying in healthy kids is caused by a sensitivity to a cow's milk protein. When severe unexplained crying occurs in otherwise healthy infants, prevalent causes include sensitivity to a cow's milk protein.

Mothers who are breastfeeding should try tweaking their diets, like taking out caffeine, chocolate and garlic, which are known to promote acid reflux. Try smaller, more frequent feedings and hold the baby upright during feedings. To calm crying babies, rhythmically rock them or take them on a car ride, experts said.

"I think there are very limited reasons, if any, to use these drugs," said Dr. Ian Holzman, chief of newborn medicine at Mount Sinai School of Medicine. "The risk is that eliminating gastric acid leads to a change in the normal bacteria in your GI track, which could have implications for infection, immunity and digestion. Most, maybe all, babies spit up and no treatment is required. I know of no good evidence that this practice has a value."

"Parents can hardly be blamed for becoming rattled and concerned about their crying infant," said Hassall. "It is important to acknowledge their concerns, explain the spectrum of normal infant behavior, discuss the range of measures available, start implementation, and be available for follow-up."