Infants with reflux–medication risk

I have touched on this subject before so I’m sorry to “go on” a bit.  However, the subject–the use of medications for babies with reflux–is very important, and there is some significant new information that I wish to share, so here goes.

Another large study now demonstrates additional risks of side effects besides those previously reported with the use of certain medications in the management of reflux in the first year of life: “PPI’s (proton pump inhibitors) like prilosec (omeprazole) or prevacid (lansoprazole) and the more commonly used “H2 (histamine type 2 receptor) blockers” like zantac (ranitidine).

The study reviewed cases in 874,447 children born between 2001-13 in the US Military System who had taken the above medicines in the first year of life and were followed for at least 2 years afterwards (so they had really good records and really good follow up). The children tended to be at least slightly premature and of lower birth weight.  Children who took PPI’s had on average a 23% greater risk of bone fractures and those receiving H2 blockers had 13% greater risk.  Taking both increased the risk by 32%; those who had one fracture had an increased risk of repeat fracture by a whopping 85%.  The risk was slightly greater in boys and the majority of the children received these medications in the first 6 months of life.  Longer treatment was associated with increasing risk.  For PPI’s, <1mo treatment had 19% increased risk, 23% for 60-150 days, and >150 days the risk was 42% greater.  For H2’s  the numbers were < 1 mo 14% greater risk, > 120 days of treatment demonstrated 22% increased risk.  Children who received both medications for > 9 months had a 50% greater risk of bone fractures.

These drugs are not infrequently prescribed for symptoms such as fussiness, poor feeding, arching, or frequent spitting up/vomiting.  Yet controlled double blind studies have not shown any discernible benefit for these symptoms from their use–children who receive placebos or no medicines appear to do just as well over time.  Now, I do not wish to imply that there is no place whatsoever to ever consider these treatments for children with some of those problems.  Nevertheless, we must remember that these are not benign medicines, as noted here; additionally, we should recall the other established risks from GER medicines in infants like malabsorption and poor weight gain, increased risk of infections like pneumonia, and kidney inflammation.  Let’s take the conservative, more natural approach for the large majority of children who’s symptoms are mild to moderate and will be well managed that way, and in particular for those “happy spitters”–the little kids who barf all over everybody and everything while happily growing and developing normally.

For babies with more severe and disruptive symptoms, give me a call and let’s discuss it.  And thanks for following.

 

 

 

 

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