Almost a decade ago headlines began warning of the increased risk of fractures for older patients on proton pump inhibitor (PPI) medications. At that time those of us with children on PPI medications were left to wonder how these results would apply to our growing kids. The theory at the time was that because the aging population is already at a greater risk for fractures it could be part of the increased incidence seen in these studies. The bottom line is that there just wasn’t enough data to know how these medications would affect our children in the long run -- so we weighed the risks versus the benefits and tried to mitigate side effects as much as possible.
In the last few years more studies have been done on the risks of taking PPIs. In May 2017 at the Pediatric Academic Society Meeting in San Francisco research was presented that examined the records of children born between 2001 and 2013 in the Military Healthcare System (MHS). Of 874,447 children, 10 percent were found to have been prescribed antacids within the first year of life. When broken down by medication the researchers found that children prescribed PPIs had a 22 percent increased risk of childhood fractures and those prescribed both H2 blockers and PPIs increased the likelihood of fracture to 31 percent. The H2 blockers alone did not appear to change the risk of childhood fracture on their own but more research will be needed to see if there are changes over longer periods.
So, what does that mean for infants and children who need medication for their acid reflux? As I have stated before the most important thing to do is to work with your child’s physician to keep him on the lowest effective dose of medication for the shortest period of time. This means frequently following up with your child’s doctor and developing a plan to wean him off of medications whenever possible.
Also, you’ll find that many of these medications are over the counter. In your young child, discuss the best course of action with your provider before using these medications on your own.
Talk with your physician about when it’s appropriate to start with lower level antacids or H2 blockers alone and when PPI medications are the only option. There may be some instances where PPIs are required but limiting their use to cases that are more severe may be the prudent thing to do.
Don’t forget that there are lifestyle changes even in infants that can reduce acid reflux. These can include proper positioning after feedings, thoroughly burping your baby, trying one of the specialized formulas for acid reflux and even starting probiotics. Work with your doctor to find the right combination for your child.
But if your child was on acid reflux medications as an infant — don’t worry too much! Instead, focus on open dialogue with your physician — especially if your child has had multiple fractures. Boosting bone health with a healthy diet of calcium-rich foods, a little sunlight for vitamin D and keeping your child physically active to build bone density can go a long way toward good bone health. In some instances your physician may recommend vitamin and mineral supplementation — but always check with your doctor first to insure you supplement properly and safely.