Are Too Many Babies Getting Acid Reflux Drugs?

Are Too Many Babies Getting Acid Reflux Drugs?

Pediatrician Suggests Many Healthy Infants Are Prescribed GERD Drugs Unnecessarily
 

 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, Hassell 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."

Pressure to Prescribe

Hassell 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, Hassell 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," suggests Hassell.
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.

Spitting Up in Babies

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," writes Hassell 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: Hassell, E. Journal of Pediatrics, published online Oct. 20, 2011.Eric Hassell, MD, pediatric gastroenterologist, Sutter Pacific Medical Foundation, San Francisco.Esther Israel, MD, pediatric gastroenterologist, MassGeneral Hospital for Children, Boston.©2011

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Traditional Causes Of Death In Pregnant, Postpartum Women Outpaced By Homici...

Violent deaths are outpacing traditional causes of maternal mortality, such as hemorrhage and preeclampsia, and conflicts with intimate partner are often a factor, researchers report.
"We found that the mortality rate from homicide and suicide were more common than what we think of as traditional causes of maternal mortality," said Dr. Christie L. Palladino, an obstetrician-gynecologist and educational researcher at Georgia Health Sciences University. "It's not what you want to read, but it's the reality."

The analysis of the Centers for Disease Control and Prevention's National Violent Death Reporting System, a surveillance system from 17 states, found 94 pregnancy-associated suicides and 139 homicides from 2003-07. Overall, 64.4 percent of pregnancy-associated violent deaths - classified by the CDC as death during pregnancy and the following year - occurred during pregnancy. The mortality rate was 4.9 per 100,000 live births.
The findings, published in the journal Obstetrics & Gynecology, are a wakeup call for health care providers and families alike about the need for mental health awareness and treatment at a time typically associated with great joy, said Palladino who is working to enhance training of obstetrician-gynecologists in depression diagnosis and treatment.

"We have a lot of studies looking at the effects of pregnancy on the baby but often we don't focus so much on outcomes for moms, and the most disastrous of those for both mom and baby would be suicide," Palladino said. She noted that homicide and suicide are both potentially preventable. "The more we look into ways to prevent suicide, ways to effectively manage women with mental health diagnoses during pregnancy and postpartum, the more we can take steps to prevent these deaths," she said.

Among the suicides, 45.7 percent occurred during pregnancy and problems with current or former partners appeared to contribute to more than half. Older, Caucasian women were at greatest risk. Among homicides, 77.7 percent occurred during pregnancy and more than half the women were age 24 or younger and unmarried. Nearly half were black, even though black women accounted for less than 20 percent of the live births, and 45 percent were associated with violence from a current or former partner.

In follow-up, Palladino is surveying practicing physicians about their practice patterns in treating depression during pregnancy. She and her colleagues also want to learn more about precipitating circumstances such as substance abuse, stress and mental illness and treatment. Studies already indicate that intervention lowers the recurrence risk of intimate partner violence in pregnancy and postpartum.

It was her early experience as an obstetrician-gynecologist who felt ill-prepared to treat depression in pregnant women that got her interested in the topic. A 2003 report in The British Journal of Psychiatry identifying suicide as the leading cause of maternal death in Great Britain sealed the deal. "Unfortunately what we found paralleled the Great Britain findings," Palladino said.

The good news is that evidence-based guidelines for depression treatment during pregnancy or postpartum have been developed by The American College of Obstetricians and Gynecologists and The American Psychiatric Association, she said. The bad news is that women and their providers might be hesitant to seek or provide care because mental illness and pregnancy seem counterintuitive.

Collateral materials such as police, coroner and medical examiner reports also were examined as part of the CDC database to provide greater context for the cause of death. While the overall pregnancy-associated violent death rate was stable over the four-year study period, those numbers could be underreported because the pregnancy or postpartum status was marked "unknown" in the majority of female deaths in the CDC database, the researchers noted. Pregnancy or postpartum status also could be missed because autopsies might not include a pregnancy exam, might miss postpartum signs or might fail to report pregnancy status on death certificates.

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