> In my corner of the world GER is massively overdiagnosed Gonneke,
> Dutch IBCLC, LLLL in Germany
>
In my experience, many babies who are diagnosed with GERD improve
dramatically when their parents are taught how to do the 5 S's
correctly.
Over the past 25 years, the number of children given a diagnosis of
GERD has increased 20-fold.1 Many of those patients are infants younger
than 3 months. Reflux is rarely associated with irritability.2 In one
study, only one in 24 infants under 3 months referred to a
gastroenterologist for evaluation of unexplained crying had an abnormal
pH probe.3 In a double-blind, crossover study, Moore and colleagues
treated 30 irritable infants (3 to 12 months of age) who had GERD
(without erosive esophagitis) with omeprazole. The medicine
significantly decreased esophageal acidity, but did not reduce
irritability.4
Part of the overdiagnosis of GERD as the cause of crying is because of
the mistaken idea that a baby who cries and writhes shortly after
beginning a feed has acid pain. In most cases, these babies are merely
responding to an over active gastro-colic reflex (or are overly
sensitive to a normal gastro-colic reflex)_ or the mom has an
overactive letdown.
Best current estimates are that, at most, only 2% to 4% of colic is
secondary to GERD. This, coupled with the fact that antireflux
medications have a significant potential to cause morbidity, should
temper a practitioner's eagerness to prescribe these agents.
Metoclopramide may increase crying, ranitidine tastes terrible, and
recently released medicines may have serious health effects that have
yet to be realized (after years of widespread use, cisapride was taken
off the market after being associated with 302 deaths, 24 in children
younger than 6 years of age). Furthermore, labeling a child as having
GERD may increase the chances of his parents seeing him as a
"vulnerable child."5
Neither food intolerance nor GERD causes the majority of cases of
colic. Neither explains:
1) the peaking of colic at 6 weeks and its disappearance at 3 months
(gastroesophageal reflux peaks at 4 months of age and lasts eight to 12
months 6);
2) the delayed onset of colic in premature babies;
3) the worsening of colic in the evening;
4) the benefit of rocking or shushing;
5) the absence of persistent crying in several other cultures.
Happy New Year to All!
Harvey
1. Tolia V: Newer developments in gastroesophageal reflux. Presented
to American Academy of Pediatrics National Conference, Boston, Mass.,
October 21, 2002
2. de Boissieu D, Dupont C, Barbet JP, et al: Distinct features of
upper gastrointestinal endoscopy in the newborn. J Pediatr
Gastrointerol Nut 1994;18:334
3. Heine R, Jaquiery A, Lubitx I, et al: Role of gastro-oesophageal
reflux in infant irritability. Arch Dis Child 1995;73:121
4. Moore DJ, Tao BS, Lines DR, et al: Double-blind placebo-controlled
trial of omeprazole in irritable infants with gastroesophageal reflux.
J Pediatr 2003;143:219
5. Sutphen J: Is it colic or is it gastroesophageal reflux? J Pediatr
Gastroenterol Nutr 2001;33:110
6. Vandenplas Y, Sacre-Smits L: Continuous 24-hour esophageal pH
monitoring in 285 asymptomatic infants 0–15 months old. J Pediatr
Gastroenterol Nutr 1987; 6:220
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