Children's Health: No Quick Cure for Baby's Acid Reflux
Babies spit up. In years past, parents dealt with this fact of nature by holding infants upright and covering the furniture with spit-up cloths. But in recent years, pediatricians increasingly have prescribed acid-suppressing drugs like Prilosec and Zantac for babies with reflux. The only problem: There's no evidence that the drugs help reduce spit-up.
Ajay Kaul, a pediatric gastroenterologist at Cincinnati Children's Hospital Medical Center, tested 30 babies under 1 year old: About one third were dosed with a proton-pump inhibitor like Prilosec, another third took an H2 blocker like Zantac, and the rest were unmedicated. Using a wireless sensor on a thin plastic tube that is threaded through the baby's nose into the esophagus, he found that the drugs didn't reduce the number of spit-up incidents to any appreciable degree. Kaul presented his research—the results have not been peer-reviewed or published—last week at the meeting of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition. "At the doses we're currently prescribing, it's not making a difference at all," Kaul says. And this is despite the fact that babies are often given as much medication as adults.
Kaul's finding is what pediatric gastroenterologists have long suspected, says Samuel Nurko, a gastroenterologist at Children's Hospital Boston. "Most babies are happy spitters," he says. A very small percentage of babies with reflux go on to have respiratory ailments including asthma, and there is much debate among gastroenterologists as to whether reflux could be causing that. "What is the importance of nonacid reflux? We don't know." But, he says, for the vast majority of children, reflux is normal and doesn't need to be treated with medication. "I don't want parents to be concerned that happy spitters are going to go on to get asthma."
"We used to tell parents that babies reflux, and they're going to outgrow it," says Robert Baker, a professor of pediatrics at the SUNY medical school in Buffalo. "Now it seems like we're almost always treating it with medication." Indeed, although 50 percent of 3-month-olds spit up at least once a day, only 5 percent of 10-to-12-month-olds do. The unanswered question, Baker says, is whether giving the drugs to babies may make them less irritable, at least in their parents' eyes. "I do believe that we are overusing acid-suppressing medicines, certainly in newborns and probably in kids less than a year."
Kaul is continuing his research and has tested almost 100 babies so far, with similar results. The benefits of acid-reflux drugs have been clear in adults and older children, but he says more work needs to be done to know if the drugs are worth giving to babies. "We need to do more studies to look at the clinical response," says Kaul. "And we need to ask parents if it's helping the symptoms."
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