I received a publicist driven email on my iPhone during clinic today that a reporter from the Chicago Tribune wanted to discuss the overuse of reflux medications. I was unfortunately up to my ears treating babies sick with reflux and was unable to help.
His query was no doubt concerning a study published in the journal Pediatrics this month where we learned that babies who spit up are frequently and unnecessarily prescribed reflux medications. As no surprise, the majority of the treated babies in this study weren’t ill and lacked any concerning signs or symptoms of reflux. For those of us who do this for a living, this study tells us nothing new. It should, however, serve as a reminder to pediatricians (especially those in rural Lousiana where the study was conducted) that happy spitters don’t need treatment.
While we may expect over the coming days to hear about the negligent overuse of medication by heartless, pill-happy pediatricians, the public can rest assured that standards for the treatment of acid reflux in children do exist. Such standards were set forth by the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition in a 2001 position paper. The results of this most recent study, however, tell us that we have more work to do. Data presented at our national convention two years ago suggested that 75% of American pediatricians were unaware that such guidelines for reflux even existed.
So who are the babies in need of reflux medications? Bottom line: those who are sick. Specifically we treat babies with difficulties feeding, growing and breathing. But of course, no two babies are alike and the decision to treat babies sick with reflux requires attention to the individual under consideration. But as I discuss in Colic Solved, the sick babies and the happy spitters are easy to recognize. It’s the grey-zone babies who create the real dilemma for the busy clinician.
Given the Medco data and this new study, expect to hear lots more about childhood reflux in the coming weeks.