Are Acid-Reflux Meds Overprescribed For Infants?
15 CommentsBy Ed Silverman // November 6th, 2007 // 8:59 am
That’s the suggestion in a new study in Pediatrics that found fewer than one in five babies given anti-reflux meds. Looked at another way, this means four out of five infants included in the study probably didn’t need such a drug, and may have simply been experiencing normal infant regurgitation, which parents refer to as “spitting up.”
“In the absence of red flags, such as a child who is not gaining weight, has feeding problems or a learned aversion to food, a chronic cough or recurrent respiratory problems or apnea, regurgitation may not require medication,” Vikram Khoshoo, a pediatric gastroenterologist at the Pediatric Specialty Center at West Jefferson Medical Center in New Orleans, the study’s author, tells HealthDay News. “Regurgitation won’t improve with anti-reflux medications. Acid suppression will improve irritability and feeding problems, but it won’t change spitting up. As long as the child is gaining weight and happy, and has no recurrent red flags, regurgitation is a laundry problem, not a medical problem.”
Indeed, Reflux is common in infants, as any parent or dry cleaner will tell you. More than half experience reflux symptoms during the first three months of life, according to the National Institute of Diabetes and Digestive and Kidney Diseases. As HealthDay notes, symptoms of reflux include spitting up, vomiting, coughing, feeding difficulty and irritability.
Khoshoo and his colleagues reported that back in 1998 and 1999, infants with regurgitation made up about 14 percent of their referrals, and about 40 percent of those babies were already on anti-reflux medication or on special easier-to-digest formula. But by 2006 to 2007, infants with regurgitation accounted for 23 percent of their referrals, and 90 percent were already on medications or special formula. “We felt it was unlikely that the incidence had increased so suddenly,” he observes.
To measure whether or not these infants’ symptoms were caused by acid reflux, the researchers conducted pH studies on 44 babies with persistent regurgitation. The average age of the babies was 18 weeks. To complete a pH study, doctors must thread a wire down the nose and leave it in place for 24 hours, Khoshoo said, so it’s not a test that would be practical to do on every child with regurgitation.
Of the 44 babies tested, only eight showed elevated pH levels, meaning they had excess levels of stomach acid, and anti-reflux medications would be indicated in these cases. However, 42 of the babies were already on such medications, meaning that many were taking a medication they didn’t need.
While these meds are generally considered safe, Khoshoo says there is some concern that they may affect calcium metabolism, and they’ve been associated with osteoporosis in older people who take them for long periods of time.Because infants are building new bones, this potential side effect is even more concerning, he adds.
David Keljo is a pediatric gastroenterologist and director of the Inflammatory Bowel Disease Center at Children’s Hospital of Pittsburgh, says that “reflux in babies is a tough issue, and I think the concerns in this study are well-raised. Babies may be cranky from reflux or from something else. The vast majority will outgrow their reflux whether we do anything or not.”
Both Khoshoo and Keljo says these meds are probably overprescribed because parents want to do something to stop their babies’ regurgitation and irritability.
Source: HealthDay News
James
I think the last sentence is the most telling of all: “these meds are probably overprescribed because parents want to do something to stop their babies’ regurgitation and irritability.”
Not the evil pharma companies pushing off-label uses and hiding data. Not the doctors bought off by the evil drug companies.
But lazy, clueless parents who would rather medicate their child than clean a little spit off their shirt. Maybe if parents would take an active role in the lives of their kids, instead of letting television, radio, the Internet, teachers etc take care of their children, we wouldn’t have kids who are overmedicated, overstimulated, and overlooked.
Maybe if a parent asked “why do the doctors want to put my kid on an antidepressant? What is going on in my house that might be depressing my child? Am I talking to my child?”
Nah. That’s all too hard. Where’s that OTC cough syrup for infants?
Laurie
“But lazy, clueless parents who would rather medicate their child than clean a little spit off their shirt.”
You can’t say in one argument that a parent has to work with a doctor for answers to a childs health problem(since they are not able to understand a medical journal) and in the next breath accuse parents of lazyness when they follow a doctors advice.
How about a doctor saying “No, you don’t need a drug for your child. This is a normal part of growth and development?”
Yes, our children are overdrugged, but parents don’t write the script. Current medicine has made normal a pathological disorder. So don’t blame parents when they follow the trend that medicine as started.
Doctors and all health professionals need to take more time to educate patents, which is this day of 5 minute office visits, is sorely lacking.
James
Who said anything about reading a journal article? I didn’t read one.
The argument is a simple one–your baby spits up. Your baby is fussy. Your baby–is a baby. That’s what they do. Clean the spit off and deal with the crying. If the baby isn’t gaining weight, that’s an actual problem.
Common sense. No journal article needed :)
Laurie
There are some posters on here that commented that parents couldn’t understand a medical journal…and should just listen to their doctors.
The death of common sense is rampant!
Lisa Van S
James,
Parent 101: Babies communicate by crying, are you suggesting, that walking away and letting the baby cry is a good thing?
It appears your speaking out of both sides of your mouth, because if you ask NAMI NJ they will tell you that “YOU” the Parent are not responsible for whats happening to your child:see their brochure here:
http://www.naminj.org/programs/educating_the educators/educating_the_educators.htm
Lisa Van S
http:naminj.org/programs/educating_the_educators/educating_the_educators.htm
Lisa Van S
Sorry about that..Third try is a charm.
http://www.naminj.org/programs/educating_the_educators/educating_the_educators.htm
Nathan
James,
Given your forceful statements above, I assume you don’t take ibuprofen when you have a headache and Sudafed when you have a stuffy nose. However, most Americans do take OTC medications to relieve simple aches and pains of life. When I give medication to my children, (including reflux medication to my infant), it is for their comfort as well as my sanity. Every time I take Tylenol to relieve my headache, I’m very thankful that I live in the 21st century and not in the 18th century when such luxuries were not available. If you would like to continue living in the 18th century, that’s your business. But get off your soapbox and stop judging the character and motives of those of us who enjoy living in a modern world. If you want your baby to continue to spend his/her nights screaming in pain from reflux, that’s your prerogative. I choose to do whatever is in my power to alleviate her suffering.
James
Lisa, I don’t care what NAMI NJ has to say in re: parents’ responsibilities, and have never so much as referenced them, so I’m not going to discuss your link. Nice attempt at a straw man, though.
Nathan, looks like I struck a nerve. If your baby is one of the rare ones who has an actual issue with acid reflux, then you certainly should medicate that child, since that is what it is designed for. If, however, you are doing it for your “sanity” so you don’t have to hear your baby cry, then maybe you should have thought about what being a parent really entailed before doing so. After all, I’ve yet to see on the indications panel of Prilosec “use when parent is tired of hearing their baby cry.”
The argument you make makes me think of the parents who exercise no discipline over their children at the grocery store or in a restaurant, who buy minivans with televisions in the headrests so they don’t have to talk to their children in the car, overmedicate their children with drugs both OTC and prescription, and then sue companies when their child has an adverse reaction or attempts suicide due to the anti-depressants they administered to their children.
I hope you aren’t going to become one of those parents, Nathan.
Hank
Many of today’s stories circle on the same theme - the enormous increase in the use of both OTC and rx meds in kids, including infants, whether PPIs, psychotropics, decongestants, etc.
Let me reframe the issue of who is ultimately responsibile. Logically, it’s the parent who puts the pill in the child’s mouth. Logically, it’s the doc who writes the script (except for OTC). And logically, it is obvious that the industry has found a market for millions of scripts and OTC meds on an entirely different scale than just a few years ago.
I don’t think it serves us to try to separate one part of this contellation from the rest. A hell of a lot more kids are being given a hell of a lot more drugs. Beyond what that may mean in any particular instance re: what is medically appropriate, we clearly have a cultural and public health phenomenon here.
The question becomes: Will we have the will, the ethics, and the science to view it with as much objectivity as can be mustered.
Reality
Laurie,
I was the one who said that your average (key word: average) person probably cannot fully and adequately understand a journal article and I stand by that. I also don’t think your average person can fully understand a legal brief, stock prospectus, architectural plan, computer code, string theory, Gravity’s Rainbow, or any other highly specialized document.
But I’ve never said they shouldn’t be informed or that they should just go along with what their doctors say. Rather, they should work with their doctors (along with whatever information they’ve found) to decide on a course of treatment.
However, part of the problem is that even with being informed, there is so much misinformation out there from myriad (unchecked) sources that the lay public doesn’t have the background necessary to assess everything critically.
Laurie
“What is medically appropriate?”
That is the key to this. It’s not one person or company that has made this possible. It’s, as you say, a culture of drugging. Where is the ethical line? Medicine says that giving a child with a cold a drug is not ok, but other doctors are prescribing antipsychotics to “bipolar” two year olds.
You have one side of the coin saying you are a bad parent if you allow your child to take a medication, and the other side saying your a bad parent if you don’t give them the medication.
I don’t have the answer, but it’s no wonder that parents are confused.
Laurie
“However, part of the problem is that even with being informed, there is so much misinformation out there from myriad (unchecked) sources that the lay public doesn’t have the background necessary to assess everything critically.”
Couldn’t agree more. But that same misinformation can play a big part in a physicians decisions. As a medical professional I see that misinformation every day. As a parent I made decisions based on misinformation.
As I’ve said before, I don’t have the answer, but what we are doing now isn’t it.
Lisa Van S
Hey James,
Here you have a so called, “Respected National Organization” saying Parents arent to blame,and you go silent…What a Wuss..Learned that term from my kids!!!
Hank
re: “medically appropriate,” yes, I was distinguishing between a decision made about a particular child - based on every relevant dimension that is knowable (and inevitably many that are not) - and what is going on culturally.
Of course, these are not independent of each other, just different levels of looking at the situation. I raised it because arguments like “Well, this is what my child needed” don’t address the wider seachange we’ve seen re: kids and drugs in general.