WHAT ABOUT YOUR BABY’S REFLUX (GERD) PROBLEM?
Although PROTON PUMP INHIBITORS (PPI’s, otherwise known as stomach acid blockers) are one of the more commonly-prescribed class of drugs in a nation that consumes mass quantities of drugs in the first place (HERE), they’ve been in the news (as well as numerous attorney ads) for the past several years not only because of their increasingly-exposed SIDE EFFECT PROFILE, but because they are mis-prescribed almost 100% of the time.
I vividly remember the shock I had the first time I had a patient tell me that their baby (one month old) had been prescribed a PPI — sometime around Y2K. Now it’s common. How common?
- In the December 2014 issue of the Journal of Pediatric Pharmacology and Therapeutics, scientists working for the drug company, AstraZeneca published a study titled Proton Pump Inhibitor Prescribing Patterns in Newborns and Infants that concluded, “Our analysis showed that PPIs were prescribed for approximately 5000 newborns and 15,000 infants (2.65%) each year in the hospital setting and 1.6% of newborns and infants, as a group, in the outpatient setting. Newborns and infants receiving PPIs most often had diagnoses of gastroesophageal reflux disease (GERD) and were generally prescribed an adult PPI dose….” An adult dose for newborns and infants — isn’t that special?
- Just months before that, pediatricians working in both Salt Lake City and Kansas City published their research in Pediatric Drugs (Proton Pump Inhibitors in Pediatrics) stating, “Treatment of all ages of pediatric patients with proton pump inhibitors (PPIs) has expanded dramatically during the last 3 decades as concerns about peptic acid diseases in adults and children have increased. Based on data from four geographically diverse commercial healthcare claims databases including 12.9 million members and 1,308,126 infants under 12 months of age, prescriptions for PPIs increased 7.5-fold from 1999 to 2004.” What about effectiveness of these drugs in babies?
- A handout for Medicaid patients called Proton Pump Inhibitors: Use in Pediatric Patients (it honestly looks and reads like a drug ad) said this of their efficacy. “Clinical trials for the use of PPIs in infants have been conducted with esomeprazole, lansoprazole, and pantoprazole. The results of these trials showed that PPIs are not effective in patients younger than one year old for the treatment of symptomatic GERD.” But the real question is are they safe?
- In June of 2014, Dr Jeannette Y. Wick, writing for the Pharmacy Times (Kids and GERD: Are PPIs Safe?) said this. “There has been an increase in the use of proton pump inhibitors (PPIs) to treat pediatric GERD…. The April 2014 online version of Drug Safety published a comprehensive review of PPI use in children. The authors discuss PPI efficacy, safety, and tolerability, restricting their coverage to pediatric GERD…. The authors indicate that emerging evidence suggests PPIs may not be as benign as previously believed. Studies have found serious side effects in some infants (eg, respiratory tract infections, diarrhea) and children aged 1 to 11 years (eg, vomiting, diarrhea, abdominal pain).“
- Just this month, the American Academy of Pediatrics published a Clinical Report titled Diagnosis and Management of Gastroesophageal Reflux in Preterm Infants that showed firstly that doctors can’t even agree on what constitutes GER / GERD (“there is as much as a 13-fold variation in its diagnosis and treatment across NICU sites“). From there the author went on to say (I’m CHERRY-PICKING due to constraints on time)…
“GER in preterm infants is most often diagnosed and treated on the basis of clinical and behavioral signs rather than on specific testing to prove or disprove pathology, and many infants continue to be treated after they are discharged from the hospital. Indeed, routine use of anti-reflux medications for the treatment of symptomatic GER in preterm infants was one of the therapies singled out as being of questionable value in the recent American Academy of Pediatrics (AAP) Choosing Wisely campaign.
The primary mechanism of GER in preterm infants is transient lower esophageal sphincter relaxation (TLESR). TLESR is an abrupt reflex decrease in lower esophageal sphincter (LES) pressure to levels at or below intragastric pressure, unrelated to swallowing. Preterm infants have dozens of episodes of TLESR each day, many of which are associated with some degree of GER. As such, GER is a normal phenomenon in preterm infants, which is exacerbated by a pure liquid diet and age-specific body position.
Preterm infants with clinically diagnosed GER are often treated with pharmacologic agents; however, a lack of evidence of efficacy together with emerging evidence of significant harm (particularly with gastric acid blockade) strongly suggest that these agents should be used sparingly, if at all, in preterm infants. GER is a normal developmental phenomenon that will resolve with maturation.”
Not particularly effective and not nearly as safe as we’ve been led to believe (not surprisingly they are also being linked not only to OSTEOPOROSIS in adults, but BONE FRACTURES IN CHILDREN). Not to mention the fact that (are you ready for this shocker?) babies burp up (TLESR). What’s a person to do if you feel they may be burping up more than “normal” (whatever normal really is)?
Firstly, read Dr. Robert Mendelsohn’s book (he was a world renowned pediatrician and educator), HOW TO RAISE A HEALTHY CHILD IN SPITE OF YOUR DOCTOR. Secondly, if your child has COLIC, click the link. And thirdly, if you want to learn why stomach acid is not your enemy but your friend, HERE is the place to start. And if you know someone that needs this information, a great way to reach them is on FACEBOOK (like, share, or follow).