Acid Reflux Drugs and Infants: Is Your Doc Over-Prescribing?

No parent enjoys seeing their infant frequently spitting up or crying often and with no explanation. If you’re a parent, that can be pure torture! But as a society, are we too quick to seek medical treatments - especially ones that can be potentially dangerous?

These symptoms, in addition to irritability, are a common occurrence during a newborn's development cycle; yet worried parents immediately schedule an appointment with the pediatrician. After a check-up, the pediatrician will often prescribe drugs that suppress stomach acid in an effort to treat the infant for gastro-esophageal reflux disease, or GERD. While seemingly proactive, GERD is actually an uncommon cause of these symptoms. And according to a recent report, over-medicating your infant could lead to further complications.

The report, written by Dr. Eric Hassall, a Staff Gastroenterologist at Sutter Pacific Medical foundation in San Francisco that is also affiliated with the Department of Pediatrics at the University of British Columbia in Vancouver, Canada, will be published in The Journal of Pediatrics. Dr. Hassall, who is also an advisor to the United States Food and Drug Administration (FDA), cautions against the over-diagnosis of GERD and the rising trend of increasing acid-suppressing drug prescriptions for infants. He also notes that most gastro-esophageal reflux in infants is actually not acidic, because stomach contents have been buffered by frequent feedings.

Proton Pump Inhibitors

Proton pump inhibitors, or PPIs, are an example of a drug that suppresses acid. While the FDA only approved the use of these PPIs in children over 12 months old, pediatricians are increasingly prescribing them to many children less than a year old. And for patients who do not actually have gastro-esophageal reflux disease, PPIs will do nothing to reduce the symptoms, as they are not caused by the same thing. In babies, irritability, frequent and seemingly random crying and spitting up are all symptoms of normal growth and development. Dr. Hassal states that trying to "cure" an infant of these symptoms is like "medicalizing normality," and that this is simply life we are witnessing, not a disease.

So what can happen when pediatricians are over-prescribing acid suppressants to your infant? Dr. Hassall explains that gastric acid serves as an early line of defense against infection, and plays a very important role in proper nutrition. By suppressing the effectiveness of gastric acid through drugs like PPIs, infants are at a higher risk for serious infections like pneumonia and gastroenteritis.

Prolonged use of PPIs can also lead to abnormalities in the levels of essential minerals and vitamins, including magnesium, vitamin B12 and calcium. Dr. Hassall recommends that parents keep a close eye on their infants, but to remain calm if this behavior occurs, as it is a normal part of a baby's life.  For pediatricians, other steps should be taken to avoid prescribing PPIs too early on, such as observing the symptoms closer and if there is a chance of the patient having GERD, only a small, two week dosage should be prescribed.  If the PPIs successfully treat the symptoms, then a longer dose can be advised, but if nothing changes, further studies should be performed.