New Guidelines in Treating Infant's with GERD

B.S. Dietetics, Dietitian, Health Professional
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As the concerns with side effects for some acid reflux medications mount, doctors are increasingly becoming wary of prescribing medications for infants with acid reflux.  Recent articles on the management and treatment of infant acid reflux have sought to further clarify when conservative treatments should be used in place of medications.

The following information and guidelines are important to know before treating your infant with acid reflux with medications.

GER vs GERD
Most physicians use the terms Gastoresophageal Reflux (GER) and Gastroesophageal Reflux Disease (GERD) to describe the conditions that frequently affect infants. Simply put GER or a "happy spitter" is the uncomplicated passage of gastric contents into the esophagus. GERD is reflux that is accompanied by troublesome symptoms or complications.  Parents need to be aware that 2/3 of infants with frequent spitting up actually have GER, not GERD, which means that no medication is needed.

Lifestyle changes should be tried first.
It was previous practice to try a trial run of an acid reducer, like Zantac, to see if GERD was the problem.  New recommendations suggest that lifestyle changes should be tried first to potentially avoid medications altogether.  Some of the lifestyle changes include: formula changes, thickened feedings, positional changes like keeping the baby elevated as much as possible, smaller more frequent feedings and thorough burping during feedings.

Probiotics may be tried before medications.
In the 13 years I have worked with infants that have GERD I have noticed a shift with some healthcare providers.  The use of probiotics as a first line of defense is becoming more and more common.  This is because probiotics have very few side effects as compared to what we are learning about some acid reflux medications.  Some strains like lactobacillus reuteri have shown to limit crying time and even the number of spit-ups per day.

Black box warnings on GERD medications have increased.
Black box warnings are the absolute strictest warnings that can be placed on a medication and are done when the FDA has evidence that there is a hazard associated with taking the medication in question.  Reglan, which is used to empty the stomach more quickly to reduce GERD episodes, received a black box warning for it's link to severe movement disorders in 2009.  PPI medications have recently had additional warnings added to their packaging with many watchdog groups pushing for black box warnings due to numerous risks we have previously discussed.

Referrals to a gastroenterologist may be needed.
Due to the previously mentioned issues, many pediatricians may wish to refer infant GERD cases to a gastroenterologist if they do not respond to basic treatments.  This can help parents get a more accurate diagnosis, rule out food allergies as a source of the symptoms and eliminate other conditions before perusing more aggressive GERD treatments.  In some cases surgery may be needed to treat infant GERD.

Medications will still be used when indicated.
While these statements may sound like acid reducing medications should not be used - that is not the case at all.  There are instances in which GERD medications are essential to prevent complications that could be life altering or threatening.  The newer recommendations are simply more cautious which should be reassuring to parents considering the recent news surrounding these medications.  In some cases a lower level medication like H2 blocker may be the first line of defense because they do not have the same side effect profile of PPI medications.  If PPI medications do end up needing to be used your child's gastroenterologist can monitor their labs for signs of any side effects before they become big problems.

Thankfully, most infants will outgrow their GERD before they are a year old.  Should your child continue with GERD symptoms beyond a year old it is important to see a gastroenterologist to rule out other issues.

_Jennifer has a bachelor's degree in dietetics as well as graduate work in public health and nutrition.  She has worked with families dealing with digestive disease, asthma and food allergies for the past 12 years.  Jennifer also serves the Board of Directors for Pediatric Adolescent Gastroesophageal Reflux Association (PAGER). _

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