Medications for Infant GERD & Spitting Up

The terms acid reflux, spitting up, regurgitation and gastroesophageal reflux are commonly used interchangeably to describe the backward flow of stomach contents into the esophagus or mouth. According to a review in "American Family Physician," infantile regurgitation is a harmless condition that occurs in 40 to 65 percent of healthy babies. Unlike infantile regurgitation, gastroesophageal reflux disease, or GERD, is a potentially serious medical condition that sometimes affects babies. The disorder is often treated with medications.

GER VERSUS GERD

Gastroesophageal reflux, or GER, is regurgitation that occurs sporadically in otherwise healthy infants. GER in normal and typically peaks between 1 and 4 months of age, usually resolving on its own by 12 to 18 months of age. Aside from occasional irritability, GER typically doesn't cause symptoms in infants. In contrast, GERD is associated with frequent vomiting, poor weight gain, persistent irritability, feeding difficulties, anemia, lack of energy, wheezing or noisy breathing, recurrent pneumonia and chronic cough. Due to the problems associated with GERD, medications are frequently prescribed for infants affected by this condition.

HISTAMINE BLOCKERS

Histamine blockers, or H2 blockers, reduce stomach acid production by inhibiting stimulation of acid-producing cells. Ranitidine (Zantac) and famotidine (Pepcid) are H2 blockers that may be used to treat GERD in infants. Although these medications have proven useful for treating GERD in adults and are frequently used to treat the condition in infants, few studies have evaluated their effectiveness in infants. A study published in "Alimentary Pharmacology and Therapeutics" suggests that H2 blockers might be effective for treating infant GERD, but the evidence of benefit is not compelling.

Although drug side effects are difficult to determine in infants, there is some evidence that H2 blockers may cause irritability and possibly headaches. Prolonged suppression of stomach acid production may also increase the risk for pneumonia and gastrointestinal infections. The long-term safety of H2 blockers in infants remains unproven.

PROTON PUMP INHIBITORS

Proton pump inhibitors, or PPIs, halt gastric acid production by blocking the cellular acid pumps in your stomach lining. Although they haven’t been available for as long as H2 blockers, PPIs have largely replaced H2 blockers for treating GERD in adults. Examples of PPIs include omeprazole (Prilosec), lansoprazole (Prevacid), pantoprazole (Protonix) and esomeprazole (Nexium).

No proton pump inhibitor has been approved by the U.S. Food and Drug Administration for the treatment of GERD in children younger than 1 year. Despite this fact, the authors of a review in the journal "Pediatrics" report that these drugs are commonly prescribed for infant GERD. The authors further state that PPIs are not effective for reducing GERD symptoms in infants. The North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition concur with this conclusion in their "Pediatric Gastroesophageal Reflux Clinical Practice Guidelines."

As with the H2 blockers, suppression of stomach acid production with PPIs may increase the risk for pneumonia and gastrointestinal infections. The FDA issued a drug safety communication regarding the use of PPIs. The communication warns of a possible increased risk for an intestinal infection called Clostridium difficile-associated diarrhea associated with PPI use. It is unclear whether there are other short- or long-term risks associated with PPI use in infants.

CONSIDERATIONS AND WARNINGS

Spitting up does not usually warrant medical therapy unless it is accompanied by signs and symptoms of GERD. Even if your doctor suspects your baby may have GERD, infants with this condition often respond to measures that do not involve medication, such as feeding your infant in an upright position; offering smaller, more frequent feedings; and thickening the baby's formula with rice cereal. Although medications are commonly used to treat infant GERD, there is little evidence to support this practice and safety is a concern. If medications are being considered for your baby, talk with the doctor about the potential risks and benefits so that you can make an informed decision.

Do not give your baby any over-the-counter medication unless you have first checked with your child's doctor to be sure it is safe.

REFERENCES

• American Family Physician: Gastroesophageal Reflux in Infants and Children
• Alimentary Pharmacology and Therapeutics: Famotidine for Infant Gastro-oesophageal Reflux: A Multi-Centre, Randomized, Placebo-Controlled, Withdrawal Trial
• Pediatrics: Efficacy of Proton Pump Inhibitors in Children with Gastroesophageal Reflux Disease
• Journal of Pediatric Gastroenterology and Nutrition: Pediatric Gastroesophageal Reflux Clinical Practice Guidelines
• Gastroenterology: American Gastroenterological Association Medical Position Statement on the Management of Gastroesophageal Reflux Disease
• U.S. Food and Drug Administration: FDA Drug Safety Communication: Clostridium Difficile-Associated Diarrhea Can Be Associated With Stomach Acid Drugs Known as Proton Pump Inhibitors (PPIs)

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