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Are acid-suppressing drugs prescribed too often in infants?
Date:10/19/2011

is often a normal developmental phenomenon, especially in infants 2-5 months old. Although some infants are unable to self-calm, this also improves with maturation and age.

"We are medicalizing normality," Dr. Hassall asserts, "In most infants, these symptoms are 'life,' not a disease, and do not warrant treatment with drugs, which can have significant adverse effects." He explains that gastric acid is an early line of defense against infection and is important for nutrition; by prescribing acid-suppressing medications to infants without GERD, pediatricians are putting their patients at a higher risk for infections like pneumonia and gastroenteritis. The use of PPIs in infants can also lead to abnormalities in the levels of essential minerals and vitamins, such as magnesium, calcium, and vitamin B12.

Dr. Hassall encourages his fellow pediatricians to initially explore nonpharmacological approaches, such as changes in maternal diet of breastfeeding mothers or hypoallergenic formulas for bottle-fed infants. However, if these approaches fail or if an infant has severe symptoms and is suspected of having actual GERD, Dr. Hassall suggests beginning treatment with an acid-suppressing medication for a time-limited period of 2 weeks. However, as Dr. Hassall notes, "In most cases, it is not the spitting up that should be treated. The real issue is the unexplained crying, which causes real and considerable distress and concern for parents." He goes on to say, "It is important for pediatricians to acknowledge their concerns, explain the spectrum of normal infant behavior, discuss the range of measures available, start implementation, and be available for follow-up."


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Contact: Brigid Huey
ournal.pediatrics@cchmc.org
513-636-7140
Elsevier Health Sciences
Source:Eurekalert

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