Infants May Not Need Anti-Reflux Medication
Doctors say most babies stop 'spitting up' on their own
 (HealthDay News) -- When a group of pediatricians noticed a big increase in the number of babies on medication and special formulas for digestive problems, they decided to take a closer look.
What they concluded was that many infants in the United States are probably being given anti-reflux medications unnecessarily.
Their study found that just one baby in five that had been given medication to control reflux was actually producing too much stomach acid. The other four babies were probably experiencing normal gastroesophageal reflux, or GER -- more commonly called "spitting up."
"In the absence of red flags -- such as a child who is not gaining weight, has feeding problems or a learned aversion to food, a chronic cough or recurrent respiratory problems or apnea -- regurgitation may not require medication," study author Dr. Vikram Khoshoo told HealthDay . Khoshoo was a pediatric gastroenterologist at the Pediatric Specialty Center at West Jefferson Medical Center in New Orleans at the time of the study.
More than half of all infants experience GER in the first three months of life, according to the National Institute of Diabetes and Digestive and Kidney Diseases. Most babies stop regurgitating food when they're between 1 and 2 years old.
Symptoms of normal GER include:
- Spitting up
- Coughing
- Irritability
- Poor feeding
- Possibly blood in the stool
Symptoms that might indicate a need for concern, according to the institute, include:
- A lack of weight gain or poor growth because the baby can't hold down food
- Refusing to eat because of pain
- Breathing problems
- Blood loss caused by acid reflux damaging the esophagus
But this does not seem to be a problem that medication helps.
"Regurgitation won't improve with anti-reflux medications," Khoshoo explained. "Acid suppression will improve irritability and feeding problems, but it won't change spitting up. As long as the child is gaining weight and happy, and has no recurrent red flags, regurgitation is a laundry problem, not a medical problem."
Khoshoo and several of his colleagues had noted a dramatic uptick in the number of babies being referred to their practice who were already on special formulas and medications. He said they "felt it was unlikely that the incidence had increased so suddenly."
To get a more accurate assessment of the problem, they tested the stomach acidity of 44 babies who had persistent regurgitation. Just eight showed excess stomach acid, yet 42 of the babies were on acid-suppressing medications.
Although acid-suppressing medications are considered safe, they may affect calcium metabolism, which would be of particular concern in a growing child.
"Reflux in babies is a tough issue, and I think the concerns in this study are well-raised," Dr. David Keljo, a pediatric gastroenterologist and director of the Inflammatory Bowel Disease Center at Children's Hospital of Pittsburgh , told HealthDay . "Babies may be cranky from reflux or from something else. The vast majority will outgrow their reflux, whether we do anything or not."
The most important things parents can do to try to avoid reflux, Khoshoo said, are to:
- Not overfeed a baby
- Try to keep an infant somewhat upright after feeding
- Make sure a baby is not exposed to secondhand smoke because that increases reflux
On the Web
To learn more about gastroesophageal reflux in children, visit the Children's Digestive Health and Nutrition Foundation.
SOURCES:
HealthDay News ; Vikram Khoshoo, M.D., Ph.D., pediatric gastroenterologist, Children's Hospital, New Orleans; David Keljo, M.D., pediatric gastroenterologist, and director, Inflammatory Bowel Disease Center, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center; November 2007, Pediatrics ; National Institute of Diabetes and Digestive and Kidney Diseases (www.niddk.nih.gov)
Author:
Serena Gordon
Publication Date:
Nov. 30, 2008
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