|
GERD and Medication
 All babies spit up, but only some babies have gastro-esophageal reflux disease (GERD). The difficulty is to determine which babies truly have GERD and how to treat them. GERD can be difficult to diagnosis in infants; there is no single test that makes the diagnosis. All infants will spit-up sometimes, but children with GERD spit up frequently and are in pain when they spit up. If spitting up does not seem to bother the child, even if they spit up every time you feed them, and they are gaining weight, then the baby does not have a medical problem (as Dr. McAllister likes to say, "The family has a laundry problem"). However if the baby is spitting up so much they are not gaining weight, they are in pain or they are refusing to eat because eating hurts, then they may need medical treatment. Treatments for GERD include dietary changes, behavioral changes and medications. GERD can be caused by an allergy to formula so it is reasonable to try and change from a milk-based to a soy-based formula, or for breastfeeding moms to cut milk and soy out of their diet to see if it helps. Burping a baby more frequently or holding them upright for 30-60 minutes after each feeding may help to reduce reflux symptoms as well. When these interventions do not work it is reasonable to try medications. The providers at Performance Pediatrics usually prescribe an acid reducer (Zantac) initially, but if that does not help will prescribe a PPI (Prevacid). Recently the use of acid blocking medications called proton-pump inhibitors (PPIs), such as Prevacid, in infants has been receiving more attention in the media. The FDA has documented an 11-fold increase in the prescription of PPIs for infants from 2002 to 2009, despite the fact that the medication is not approved by the FDA for use in infants. Many pediatricians and pediatric gastroenterologists use these medications because they have been shown to be effective and have very few and mild side effects. At Performance Pediatrics, we believe that it is a safe medication that improves the symptoms of reflux in babies and allows them to feed and grow in a normal healthy manner. Although rare, babies who are not getting better on medications or continue to gain weight poorly may have other anatomic problems contributing to their reflux. In these cases the providers at Performance Pediatrics may order an x-ray study called an upper GI, where the baby is fed formula containing a contrast medium that can be seen on x-ray. Several images will then be taken to evaluate the baby's internal anatomy. Occasionally Performance Pediatrics will also refer a baby to a specialist, a pediatric gastroenterologist, who may try other medications or even perform a procedure (endoscopy) that allows them to pass a camera down into the baby's stomach and look for problems. For more information on GERD, visit Kids Health. | 
