> 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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