Feb. 27, 2002 -- Fussiness and spitting up after eating is a common problem for infants, but for some babies these painful episodes may be caused by gastroesophageal reflux (GERD) -- a problem their heartburn-suffering parents can relate to. But new research shows many of the treatments frequently recommended by doctors to ease GERD in infants without drugs or surgery may be of little help.
When an infant has GERD, the contents of his stomach backs up into the esophagus, and he may vomit, have breathing problems, and fail to gain weight. Most infants grow out of the condition once their digestive systems mature by age 1, and many doctors are reluctant to prescribe medications or surgical procedures to correct the problem.
Instead, pediatricians commonly rely on conservative measures to reduce the symptoms of GERD such as adjusting the position of the infant, altering pacifier use, or changing baby formulas. But a review of studies on these methods now shows that few are proven to be effective.
The review, published in the Archives of Pediatric and Adolescent Medicine, found no clinical evidence that placing an infant upright in an infant seat reduced the amount of reflux. In addition, one study found that positioning the child at a 60-degree incline, as often recommended, increased the problem.
Other measures the review found have not been shown to reduce GERD include:
- Elevating the head of the infant while sleeping
- Changing pacifier use
- Changing the composition of formula
Several studies examined in the review looked at whether thickening baby formulas with rice flour or carob bean gum had any effect on GERD. Although neither method was found to significantly reduce reflux, researchers say thickening formula did reduce the frequency of vomiting.
Another measure shown to have at least some benefit was using a more dilute fluid. The review found that a drink containing 5% dextrose (a sugar) in water resulted in less reflux than one containing 10% dextrose.
Researchers say many medical textbooks continue to recommend these treatments even though they have not been shown to be effective, but the reasons may be psychological more than practical.
"Many pediatricians and pediatric gastroenterologists prescribe these therapies despite their lack
of evidence, often as a means of including parents in the treatment plan when reassurances seem insufficient," write the authors.
If the GERD becomes persists, pediatricians may prescribe Zantac or similar medications, such as Tagamet. These drugs, available in an infant-strength liquid, block the production of the irritating stomach acids that may be regurgitated into the esophagus, thus relieving baby's heartburn-like symptoms.