Acid-suppressing Drugs in Infants

Acid-suppressing drugs are over-prescribed for infants and, far from benefitting them, are doing them harm, argues a commentary published online last week in The Journal of Pediatrics. The commentary was written by Eric Hassall, MD, a staff gastroenterologist at Sutter Pacific Medical Foundation in San Francisco and an advisor to the FDA.

Acid-suppressing drugs are frequently prescribed for infants who spit up, are irritable, and cry without explanation on the theory that they are suffering from gastroesophageal reflux disease (GERD). However, argues Hassall, GERD is rarely the cause of these symptoms in infants who are otherwise healthy. Nonetheless, parents frequently assume that infants with these symptoms are suffering from acid reflux and obtain prescriptions for acid-suppressing drugs such as proton pump inhibitors (PPIs).

The FDA has approved the use of acid-suppressing drugs by children over a year old, but their use in infants under a year old has increased greatly in recent years. According to a study of US health care databases cited by Hassall, use of one of the PPIs available in a child-friendly formulation increased 16-fold between 1999 and 2004. Approximately 0.5% of the approximately one million infants in the study received a PPI during the first year of life, and approximately 50% of these infants started taking the PPI before four months of age.

“These data would imply that somehow the diagnosis of GERD has been missed over the past several decades or has recently become a major scourge of infants in the developed world, with acid suppressing drugs becoming a new essential food group in their own right,” Hassall writes.

Indeed, Hassall adds, studies have found that PPIs are no better than placebo for most infants who spit up, are irritable, or cry without explanation. All of these, he points out, are normal developmental phenomena, which tend to fade with time.

Of even greater concern, acid-suppressing drugs can do harm to infants who don’t need them. Since gastric acid is an early-line defense against infection and plays an important role in digestion, use of these drugs can put infants at risk of infections such as pneumonia and gastroenteritis and can lead to abnormal levels of key minerals and vitamins such as magnesium, calcium and vitamin B12.

Source:

Over-Prescription of Acid-Suppressing Medications in Infants: How It Came About, Why It’s Wrong, and What to Do About It [The Journal of Pediatrics]