Reflux in Infants (or Gastroesophageal Reflux Disorder / GERD) is a shockingly common diagnosis in infants. There is a lot of controversy surrounding the diagnosis and treatment of this condition in this special population. My task here is not to fuel that fire, tell parents what choice is best for their specific situation, or replace medical advice. My goal is to provide a framework of understanding so that caregivers can feel confident and well-informed in their decision making process.
This is Part 2! If you are looking for more background information on GERD, please read Part 1 first!
Conventional Medical Treatment of Infantile Reflux
Believe it or not, the recommended treatment for most cases of reflux in infants is to watch and wait. As long as weight gain and other health measures are on track, babes are given the opportunity to “grow out of it”. It may be recommended that you make a few shifts in baby habits – like keeping her upright for 30-60 minutes after a feed, modifying feeding schedules and behaviours (such as interrupting a feed to burp and draining an entire breast before moving on to the other side), or raising the head of the baby’s crib so they are on a slant while sleeping. Although sleeping prone (on belly) does significantly reduce reflux symptoms, it is not generally recommended and does not follow the “Back to Sleep” campaign suggestions. Many of you may have tried a lot of these on your own before heading to your health provider for further support. Adding cereal to bottle feedings as a thickening agent and introducing solids early are older recommendations that do not generally reduce overall reflux scores and I would be hesitant on those fronts. More and more often now, referral to a lactation consultant to support good latch and feeding mechanics, modification to a breastfeeding mom’s diet (usually removing dairy), or doing a trial of a hypoallergenic formula are primary suggestions in both allopathic and complimentary health practices.
In very, VERY rare cases, there are surgical options for treating extreme and persistent GERD. I have actually not yet come across any cases this drastic in my practice.
Though quite commonly prescribed by well-meaning physicians, reflux medication are NOT recommended for children with uncomplicated reflux. I repeat, pharmaceuticals are not considered best practice for reflux in infants unless there is a secondary complication such as poor weight gain (and failure to respond to more conservative measures), refusal to feed, notable inflammation of the esophagus, or chronic respiratory distress. Why would reflux medication not be recommended for reflux? Seems like a simple solution, right? Although in some cases they may be the best option, in the vast majority to cons greatly outweigh the potential pros.
Proton Pump Inhibitors/PPIs (ranitidine, Zantac) and Histamine-2 Receptor Antagonists/H2RAs (omeprazole, Prilosec, Nexium, Prevacid) are two classes of drugs that aim to reduce the amount of stomach acid secreted, whereas antacids work to neutralize stomach acid already secreted. PPIs and H2RAs are more highly considered than antacids, but none are recommended for long-term use. There is very limited research assessing the use of these medications in children, though their use in adults relatively well studied. Contrariwise, there is ample evidence to support the impact that these drugs have on the gut. All three classes of drugs have a major impact on the body’s ability to absorb nutrients (most notably calcium, iron, and B12) and can have a negative impact on immune function, increasing the risk of certain intestinal and respiratory infections (including Clostridium difficile infection). PPIs have already been shown to compromise upper GI transmucosal barrier function, which has major implications in immune function and overall health and is kind of scary to think about in infants who already have relatively permeable gut linings.
Any and all medications can impact your body’s ability to absorb and metabolism nutrients. They alter our chemistry, as they are supposed to; that’s how they work! They may deplete your supply, increase your need, or interfere with the activity of individual nutrients depending on the chemistry at play. Knowing these Drug-Induced Nutrient Depletions can help use limit or prevent side effects and sometimes actually enhance the effectiveness of the medication. Here are some specific nutrients to consider with these medications.
They also all impair protein metabolism as protein requires high stomach acid to begin its breakdown process.
Medications are not always a bad choice, but it is best to know the pros and cons. Be aware of potential side effects and nutrient interactions and make an informed choice that you are comfortable with. If you and your healthcare provider decide that medication is what is best for your infant, know that you can support the altered chemistry and that you will need to provide additional nutrients and an opportunity for the gut to heal and restore after usage. You should absolutely always consult with your prescribing doctor and/or pharmacist before modifying any current medications.
Now that you know more about the standard treatments, learn more about the complementary treatments that can be used in conjunction with or often help minimize the need for medical management on infantile reflux. Continue on to read Part 3: Conservative Care.
Looking for references and resources? They are at the end of Part 3.