Medscape did an article abstracting the info from the Pediatrics, commenting
on the fracture risk.  Here's the Medscape ref: Reflux Guidelines: Modest
Changes Best for Most Infants. Medscape. Apr 29, 2013.. I quote it here

 

Reflux Guidelines: Modest Changes Best for Most Infants

Diedtra Henderson

Apr 29, 2013

Two thirds of otherwise healthy infants spit up because of their physiology,
and they should be treated not with medication but with modest lifestyle
changes, such as altering their position during feeding. Medications should
be reserved for infants who actually have gastroesophageal reflux DISEASE
(GERD), according to an American Academy of Pediatrics (AAP) clinical
report. There are reports of increased risk of bone fractures from increased
ingestion of reflux meds with calcium, etc.

Jenifer R. Lightdale, MD, MPH, from the Boston Children's Hospital in
Massachusetts; David A. Gremse, MD, from the University of South Alabama in
Mobile; and the AAP's Section on Gastroenterology, Hepatology, and Nutrition
published the guidance for pediatricians online April 29 in Pediatrics.

During infants' routine 6-month physician's visit, one quarter of parents
pepper pediatricians with questions about gastroesophageal reflux (GER),
according to the authors. Indeed, parents are consulting pediatric
specialists, and an increasing number of inappropriate prescriptions for
proton pump inhibitors (PPIs) are being written to treat pediatric patients,
the authors note.

The guideline authors encourage pediatricians to follow guidelines updated
in 2009 by the North American Society for Pediatric Gastroenterology,
Hepatology, and Nutrition, which would apply the most conservative
approaches to the vast majority of infants and would reserve more aggressive
treatments, including surgery, for children with intractable symptoms and
risk for life-threatening complications.

"In the infant with uncomplicated recurrent regurgitation, it may be
important to recognize physiologic GER that is effortless, painless, and not
affecting growth," the authors write. "In this situation, pediatricians
should focus on minimal testing and conservative management. Overuse of
medications in the so-called 'happy spitter' should be avoided by all
pediatric physicians."

At the heart of the guidelines is the pediatricians' ability to distinguish
typical spitting up from the more problematic GERD, in which vomiting is
accompanied by such symptoms as irritability, weight loss, refusing to eat,
coughing, or wheezing and is confirmed through a series of diagnostic tests.

The guidelines counsel older children and adolescents to avoid caffeine,
chocolate, alcohol, and spicy food and note the benefits of chewing
sugarless gum. For older children with heartburn, if [PPIs] are indicated,
children should take the medicine 30 minutes before eating. However, the
guidelines "strike a note of caution" about inappropriate PPI prescriptions,
which may increase the risk for lower respiratory tract infections.

"It cannot be overemphasized that pediatric best practice involves both
identifying children at risk for complications of GERD and reassuring
parents of patients with physiologic GER who are not at risk for
complications to avoid unnecessary diagnostic procedures or pharmacologic
vpharmacologic therapy," the authors conclude.

Pediatrics. Published online April 29, 2013. Medscape Medical News C 2013
WebMD,  <mailto:[log in to unmask]> [log in to unmask]

Cite this article: Reflux Guidelines: Modest Changes Best for Most Infants.
Medscape. Apr 29, 2013.

 

Jackie Levine

 


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