According to a new study by Medco Health Solutions, between 2002 and 2006, there was a 56 percent increase in the use of prescription Gastroesophageal Reflux Disease (GERD) medications for infants. Here is another alarming statistic: last year, approximately 2 million children were prescribed a GERD medication such as a Proton Pump Inhibitor (PPI) with brand names such as Prevacid and Prilosec.
So what is going on here? Is there a serious epidemic of babies with reflux? Are doctors prescribing GERD medications too readily? Are parents demanding GERD medications from the doctors? Are parents and doctors over-diagnosing GERD when it is really physiologic reflux, also known as Gastroesophageal Reflux (GER)? Does advertising about GERD medication affect medication usage? The study authors and other experts theorized that childhood obesity had led to an increase in GERD and the need for medications. But this does not explain the 50 percent surge in medication prescriptions for infants. I believe there is a combination of factors contributing to the increase in medication.
When I think of babies with reflux, it seems that there are many babies with physiologic reflux or GER and a few babies with GERD. In between are babies who are struggling with pain that affects eating, sleeping and self regulation. The babies with physiologic reflux or GER get better over time with little or no intervention, and the babies with GERD often need a combination of diet, medication and positioning with close monitoring for complications. The babies who have GER with pain leave parents and doctors struggling for solutions: Do we wait and see if the reflux gets better? Do we try medication? Do we try medication and dietary changes? Should we switch medications? Increase medications? Add another medication? Doctors are often faced with the challenge of differentiating between the baby who needs to be watched for signs of GERD and the baby who will get better over time.
My hunch is this in-between group may account for the sharp rise in medication usage. Parents with a crying baby will turn to the Internet or a parent book and suggest or even demand a prescription or other treatment. Doctors suggest home care but may not have the time to provide the instructions or follow up to make it work. Some parents will find the home care techniques (holding upright, small frequent meals) too cumbersome and demand a quick fix in the form of a medication.
Babies cry for many reasons, and reflux is just one cause of crying. Some of these babies who appear to have painful GER are crying due to other painful conditions such as food allergies and intolerances, constipation, delayed gastric emptying and hiatial hernia.
The bottom line is powerful prescription medication should only be given when other treatments have been tried and related health conditions have been considered and ruled out.
I hear both sides of the story because I talk with parents of babies with reflux and the doctors who treat them on a regular basis. Many parents are concerned that their babies are in pain, and they sometimes express displeasure at the doctor for not "fixing" the reflux. Pediatricians tell me that all of their parents think their babies have GERD and want medication. While we all wish babies with reflux came with an instruction sheet or a guidebook, it is good to know that parents and doctors have access to a step by step research based treatment guide published by the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN).
The guidelines are available on the Web here.
It is important for doctors and parents to follow the guidelines and ensure the best outcome for all babies with GER, GERD and everything in between.
See Jan's other articles on infant GERD here.