With a trend in treatment for infant acid reflux, some doctors fear that thousands of babies are needlessly medicated for the hard-to-diagnose condition
From the moment she was born, Lily Kahn was a screamer. She cried so much in the hospital that staff constantly brought the infant to her mother for comfort.
The crying didn't stop once Lily was home. Her parents, Seth and Dana Kahn, noticed that she often spat up and sometimes swallowed regurgitated formula.
Desperate, they went to the doctor. He said Lily was likely suffering from “silent" acid reflux and prescribed Zantac.
Although the couple were concerned about giving the baby medication, Ms. Kahn said they were desperate for an end to the constant crying.
“You want to do what you can for your child and for your sanity," she said from her home in Raleigh, N.C.
But three months later, the medication was still not curbing Lily's cries. And her parents were left wondering whether she even had acid reflux.
It's a frustrating scenario that is being played out with increasing frequency in cribs across North America.
Fussy babies are hardly a new phenomenon, of course. But instead of dismissing the cries as colic, more doctors are diagnosing infants with gastroesophageal reflux disease (GERD), or acid reflux, a painful condition that can be alleviated with acid-reducing H2 blockers such as Zantac or proton pump inhibitors, which stop the production and secretion of acid.
The trend to treating babies is fuelled in part by recent research showing that some of the medications can be safe and effective in children. But the number of prescriptions for infant acid reflux – a condition doctors say is hard to properly diagnose – has risen so quickly in the past few years that many pediatric specialists fear thousands of infants are now being medicated needlessly.
“I'm not saying no babies have reflux disease, but what's happened is over the last several years, the number of prescriptions in infants [for proton pump inhibitors] has risen dramatically," said Eric Hassall, professor of pediatric gastroenterology at B.C. Children's Hospital and the University of British Columbia. “There clearly is not a sudden epidemic of GERD in First World infants. … Either we've missed all of this in the past or [the medication] is being prescribed inappropriately."
Dr. Hassall and his colleagues are on a mission to rectify over-prescription, which they see as a growing problem. He co-authored new guidelines released earlier this month by the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, along with its European counterpart, on properly diagnosing and treating infant acid reflux.
He also co-authored a study published earlier this year that looked at 162 infants with symptoms often attributed to GERD, such as irritability or crying after being fed. One group of infants was given lansoprazole, a proton pump inhibitor sold under various brand names, including Prevacid, while another group was given a placebo. Researchers found no difference between the effectiveness of the drug and the placebo at alleviating symptoms. The study, published in the April edition of the Journal of Pediatrics, also found babies who were given medication had a much higher risk of serious side effects, particularly lower respiratory tract infections.
“The likely meaning, certainly, that I've inferred from this is that most of these infants actually didn't have GERD," Dr. Hassall said. “They were irritable for some other reason and therefore it didn't matter what you gave them."
Dr. Hassall also cautioned that while there is research showing the safety of acid reflux medications in children, there has been little solid examination of its effect on infants. That's one of the main reasons more doctors say there's a need to improve the process of diagnosing and treating infant acid reflux.
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