I have written a lot about fussy infants, spitting up and gastro-esophageal reflux (GERD). The diagnosis of GERD in infants in the past 10 - 15 years has soared….especially in irritable infants some of whom arch their backs and act as if they are uncomfortable while feeding (both breast and bottle fed babies) and spit up frequently, to those who are diagnosed with “silent reflux”.
When new drugs came to the market for adults with GERD, initially H-2 blockers like Zantac (ranitidine), Pepcid (famotidine) and Axid (nizatidine) they were soon prescribed for children as well. These drugs were followed by the introduction of proton pump inhibitors (PPI) which also inhibit gastric acid production, and include Prevacid (lasoprazole), Nexium (esomeprazole), and Prilosec (omeprazole). Suddenly, younger and younger children were being placed on either H-2 blockers or PPI’s and many of these prescriptions were being written for infants under 6 months of age.
Being a pediatrician who had practiced for a long time and also had a incredibly fussy, irritable and colicky baby myself….I could never really decide if these drugs worked well or if “we” wanted them to work. There were some cases where it was quickly evident that the baby’s symptoms improved, while in many others the parents “were not sure”. But, the use of these drugs has soared.
I have more and more young parents who want to start medication within their baby’s first month of life…”just because they are fussy”. But there are new studies showing that the use of these medications in young children, especially those under one year, may have lasting side effects including an increased risk of fractures. In a retrospective study looking at over 850,000 children born between 2001-2013, those prescribed PPI’s had a 23% increased risk of fractures and those prescribed H2 blockers had a 13% increased risk while those prescribed combination therapy had a 32% increased risk of fractures. The risk also increased if children took these medications before 6 months of age, and there was also increased risk for those who used medications for longer periods of time.
Take home message for both doctors and parents….if these drugs need to be used it is preferable to limit it to one type, preferably H2 blockers and for the shortest amount of time possible. The use of other remedies including herbal remedies, thickening of feeds and probiotics should be first line treatment. When symptoms persist or are worsening and GERD is suspected, a 2 week trial of medication may be considered with ongoing discussion as to improvement in symptoms. Use the lowest dose for the shortest period of time as well.