Gastro-oesophageal reflux (called reflux for short) is a normal physiological process where the contents of the stomach come back up into the oesophagus.
Reflux is common in normal, healthy babies and usually causes no significant problems.
If your baby is overall happy, eating well and growing well, no treatment may be required.
However, if there are problems a doctor may diagnose gastro-oesophageal reflux disease (GORD).
8 Important Facts About Reflux Medications For Babies
In such a situation, one or more medications may be suggested.
Common medications prescribed for babies diagnosed with GORD are acid suppressant medications, such as proton pump inhibitors. These medications reduce the production of acid in the stomach.
The idea behind giving these medications to babies diagnosed with GORD is the belief they may be experiencing pain caused by stomach acid coming up their oesophagus, with reflux leading to oesophageal inflammation and damage.
However, GORD is often diagnosed on the basis of listening to parents about what’s happening with a baby rather than objective and diagnostic tests being carried out to determine if there is or isn’t oesophageal inflammation and damage.
If your baby has been diagnosed with GORD and medication has been suggested, the potential benefits must be weighed up against the possible risks.
Here are 8 important things to know about reflux medications for babies.
#1: They Tend To Be Overprescribed
An 82% overprescription rate for acid-suppressant mediations in babies has been suggested.
Indeed, the opinion that acid-suppressant medications are being significantly overprescribed has been commonly reported amongst doctors.
#2: They May Not Help
Research has shown acid-suppressant medications prescribed on the basis of babies’ symptoms (e.g. crying, vomiting and irritability) are ineffective.
This research found parents of babies started on acid-suppressant medications reported an improvement. However, later on, when some babies continued with the acid-suppressant medication and others switched to placebo medications, there was no difference between the groups.
Hence, the perceived improvement reported by parents was either due to spontaneous improvement or a placebo effect of the medication.
Also, stomach acid is buffered for about two hours following breastmilk or formula feeds by milk. Any refluxate (acid, liquid and gas) that comes up a baby’s oesophagus in this time is not acidic and shouldn’t irritate the oesophagus and cause pain.
#3: Adverse Effects If Medication Suddenly Stopped
If acid-suppressant medication is stopped suddenly, an over-production of stomach acid can occur which may cause reflux-type symptoms.
This could give parents a false sense that the medications were actually helping their baby and feel like they need to continue with them.
#4: Medication May Increase Infection Risk
There are several important reasons why the stomach produces acid. Suppressing this with acid-suppressant medication could have negative side effects.
For example, it can increase the risk of lower respiratory tract infection such as bronchiolitis, or of bacterial intestinal infections and fungal infections .
#5: They May Increase The Risk Of Allergy
By making the stomach pH less acidic, acid-suppressant medication could result in protein molecules not being broken down.
This has the potential to allow intact proteins to pass directly into the bloodstream, increasing the risk of sensitisation and allergy development.
#6: They May Affect Nutrient Absorption
Acid in the stomach is important to help prevent bacterial overgrowth in the parts of the digestive tract that are not designed to be full of bacteria. Bacterial overgrowth can negatively affect nutrient absorption and cause diarrhoea.
Also, low stomach acid can result in poorer mineral absorption and suppress the stimulation of gastric hormones responsible for releasing all the main digestive enzymes that act in the small intestine.
#7: They May Increase Fracture Risk
The use of acid-suppressant medications in babies may increase their risk of broken bones in childhood. This association has been more strongly identified in adults using acid-suppressant medication in the long-term.
#8: There May Be Many Other Side Effects
While babies can’t report possible side effects of taking acid-suppressant medications, older children and adults who have taken them have reported side effects such as headache, diarrhoea, constipation and nausea.
Acid-suppressant medications have also associated with kidney problems and heart attack in adults.
Given the possible risks of acid-suppressant medications, there should always be an emphasis placed on lifestyle measures and reassurance to manage simple reflux as well as GORD.
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