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Acid-Suppressing Drugs Prescribed Too Often in Infants

Too many infants are being diagnosed with gastroesophageal reflux disease or GERD and being prescribed acid-suppressing drugs as a result, according to a pediatrician and advisor to the U.S. Food and Drug Administration.

Parents are often distressed by the frequent spitting up, irritability, and unexplained crying in infants. And pediatricians often prescribe acid-suppressing drugs for such symptoms in an effort to treat infants for GERD. However, Dr. Eric Hassall, staff gastroenterologist at Sutter Pacific Medical Foundation in San Francisco, Ca., and an FDA advisor, cautions against this.

Although the FDA has only approved the use of acid-suppressing drugs, such as proton pump inhibitors (PPIs), in children over the age of 12 months, the use of PPIs in infants less than one year old has greatly increased in the last decade.

Most “reflux” in infants is not acidic because stomach contents have been buffered by frequent feedings, Dr. Hassall said

“However, in the absence of better information and physician guidance and fed by advertising and misinformation on the Internet, distressed parents take their concerns to doctors, who very frequently comply and prescribe acid-suppressing medications for symptoms an d signs that, in most cases, are not GERD,” he said in a news release.

Studies have shown that PPIs are no better than placebo for most infants with symptoms of spitting up, irritability, or unexplained crying, which may be a result of the medications being prescribed for symptoms that are not GERD.

Spitting up in otherwise healthy infants is normal and resolves with time, Hassall says. Irritability or unexplained crying, with or without spitting up, is often a normal developmental phenomenon, especially in infants between 2-5 months old. Although some infants are unable to self-calm, experts say this also improves with maturation and age.

“We are medicalizing normality,” Dr. Hassall asserts, “In most infants, these symptoms are ‘life,’ not a disease, and do not warrant treatment with drugs, which can have significant adverse effects.”

Gastric acid is an early line of defense against infection and is important for nutrition; by prescribing acid-suppressing medications to infants without GERD, pediatricians are putting their patients at a higher risk for infections like pneumonia and gastroenteritis. The use of PPIs in infants can also lead to abnormalities in the levels of essential minerals and vitamins, such as magnesium, calcium, and vitamin B12.

Pediatricians are encouraged to explore non-pharmacological approaches, such as changes in maternal diet of breastfeeding mothers or hypoallergenic formulas for bottle-fed infants. However, in case these approaches fail or if an infant has severe symptoms and is suspected of having actual GERD, Dr. Hassall suggests beginning treatment with an acid-suppressing medication for a time-limited period of two weeks.

However, in most cases it’s not the spitting up but the unexplained crying that is causing the most concern for parents. Dr. Hassall suggests that pediatricians acknowledge the parents’ concerns, explain the course of normal infant behavior, discuss all available measures, then begin implementation and be available for follow-up.

For more on child medical issues, see the library of articles by Daytona Beach child injury attorney.

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