WebMD Medical News
Laura J. Martin, MD
Oct. 20, 2011 -- Babies may spit up and cry and fuss for seemingly no reason. But one children's health expert has noticed an alarming increase in the number of infants being prescribed acid-suppressing drugs to reduce unexplained crying and spitting up.
In a commentary published in The Journal of Pediatrics, Eric Hassell, MD, a pediatric gastroenterologist at Sutter Pacific Medical Foundation in San Francisco, warns that the use of acid-suppressing medications to babies under 1 year old has skyrocketed. One large study in the U.S. found a 16-fold increase in the number of prescriptions for a kid-friendly liquid form of acid-suppressing drugs between 1999 and 2004.
Despite this recent spike in prescriptions, Hassall argues that the vast majority of infants don't have gastroesophageal reflux disease (GERD), which is what these drugs are meant to treat.
"There was no good medical reason" for this huge jump in acid-reflux drug use in infants, he says. "There was no sudden epidemic of reflux disease."
Hassall suggests that a baby's inconsolable crying and spitting up, which are separate symptoms, have become combined into a diagnosis of acid-reflux disease by some pediatricians. But this spitting up likely isn't "acid reflux" because infants have frequent feedings that tend to buffer stomach acid.
Most reflux is physiological, Hassall tells WebMD. In most cases, it's not the spitting up that should be treated, he says. The real issue is the unexplained crying.
To be sure, having your little bundle of joy morph into a little one who is wailing, bawling, and red-faced is nerve-wracking for frazzled parents. And some moms and dads put a lot of pressure on pediatricians to "do something" to help their hard-to-soothe infants.
"Parents are demanding treatment and demanding higher doses of drugs," Hassall says.
It's sometimes easier and quicker for a doctor to write a prescription instead of taking the time to explain what parents can try in place of drugs. He suspects that both parents and pediatricians are unaware of the extent to which acid-reducing drugs are being overprescribed or of their potential side effects if used long-term.
We like to say that "spit happens" in babies, says Esther Israel, MD, a pediatric gastroenterologist at MassGeneral Hospital for Children in Boston. "Gastroesophageal reflux is not a disease in infants. It's a normal physiological response that babies often outgrow."
Israel admits there is a lot we don't know about why babies are irritable. Still, she notices that more and more kids are coming in to see her who are already on acid-suppressing drugs. And there is a concern that we are overmedicating these infants.
She says that before turning to medications, there are a lot of things that can be done from a behavioral perspective. These include soothing-type activities, such as rocking or patting the newborn in a quiet place. Dietary approaches such as switching from a milk protein-containing formula to a soy-based or hydrolyzed one may also make a difference. If a mother is breastfeeding, she can try eliminating milk products from her diet to see how her baby responds.
If colic is a concern, infants usually outgrow it in their first three to four months of life. And "there is no proof that unexplained crying in otherwise healthy infants is caused by pain in the abdomen or any other body part," Hassall writes in his commentary.
"The use of acid-suppressing medications in infants should be reserved for those children for whom behavioral methods and changes in formula don't work," Israel tells WebMD. And when those drugs are tried, she'll begin with a two-week trial to see if it calms a baby down.
SOURCES:Hassall, E. Journal of Pediatrics, published online Oct. 20, 2011.Eric Hassall, MD, pediatric gastroenterologist, Sutter Pacific Medical Foundation, San Francisco.Esther Israel, MD, pediatric gastroenterologist, MassGeneral Hospital for Children, Boston.
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