Overprescribing GERD Medications for Infants? Perhaps not

It is worrisome that babies with normal regurgitation or gatroesophageal reflux may be prescribed strong medication designed for the treatment of gastroesophageal reflux disease. A study just published in the November 2007 issue of the journal Pediatrics illustrates how difficult it is to differentiate between the baby with normal regurgitation and the one with GERD.

The study looked at the acid levels of infants prescribed PPI (Proton Pump Inhibitor) medications for regurgitation (spit up or vomiting). A pH probe test, considered the gold standard for diagnosing GERD, was performed on each infant in the study. The results showed that only a small percentage of the infants (8 out of 44) had abnormal pH probe test results indicating GERD. Further, stopping the PPI medication did not cause the symptoms to worsen. The authors concluded that the majority of babies in the study did not meet the criteria for GERD and therefore did not need PPI medication to treat the symptoms.

This study follows a recent report demonstrating an alarming increase in GERD medication prescriptions for infants and children. While there has been an increase in pediatric GERD, doctors and researchers are concerned that the sharp increase in GERD medication prescriptions may indicate that some infants and children do not have GERD and may be receiving GERD medications needlessly.

But as a parent and advocate for parents of infants to teens with GERD, I am concerned that this study and others will be misconstrued and cause babies to suffer. Here's why:

The PPI medications were developed to target the underlying mechanism of acid over production in adults. While more research is needed, it appears that motility (coordination of muscles and nerves to move food through the digestive tract) is the underlying cause of pediatric GERD. The motility medications that target the underlying cause of pediatric GERD have not proven to be effective and have a record of worrisome side effects. While many infants and children have benefited from PPI's, it is clear that a medication that targets the underlying cause of Pediatric GERD is still needed.

It is well established that PPI's are safe and effective for reducing stomach acid and healing esophagitis and ulcers. The North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) recommends a trial of acid suppression medication (H2 blockers or PPI's) when symptoms are suggestive of GERD. Infants and children with symptoms of GERD may be spared discomfort and sedation if a trial of medication is used rather than performing diagnostic testing to determine a diagnosis before initiating treatment. Further, it is not practical to perform a pH probe on every baby with symptoms of GERD at this time. A trial of medication is certainly a low risk treatment option for many diseases, not just GERD. Perhaps doctors and parents need to try a time limited trial of a H2 blocker or PPI with careful follow up care. Once a baby with worrisome symptoms is placed on a GERD medication, perhaps parents are reluctant to stop the medication and observe the baby. Doctors may need to spend extra time educating parents about the goal of the trial of medication and explain other proven treatment options such as giving the baby small, frequent meals, burping often and elevating the bed or crib.