> 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 *********************************************** To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or digest) To unsubscribe: unsubscribe lactnet All commands go to [log in to unmask] The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(R) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html