I don’t imagine I’m the first mother to look at her crying infant and pray for some solution. Between old wives’ tales, discussions with parents and grandparents, herbal remedies, and medications, I entertained all options to ease my baby’s tears, which were determined to be due to acid reflux.
Our pediatrician offered Zantac, which actually seemed to work. This medication, commonly used in babies with acid reflux, definitely made me nervous. But after months of sleeplessness and relentless tears (hers and mine), I diligently squirted 1 cc of bitter tasting medication in my daughter’s mouth. It crushed me to see her wince at the taste. But her crying eased and she seemed happier … until the crying resumed two weeks later.
This is a familiar crossroads that parents face: get more aggressive or just stay the course and wait for growth and time and life to take over. I knew odds were she would eventually outgrow it; but as a new parent, I didn’t know if I could watch her endure it.
Our pediatrician recommended a stronger type of reflux medication called a proton pump inhibitor (PPI). I had heard of many babies on Zantac so it had been easier to give her that. But this was scarier to me. I prescribe PPIs to my adult patients reluctantly (Prevacid, Nexium, omeprazole, Prilosec, and Protonix are among the many versions of PPIs that patients are familiar with). Hundreds of studies have proven a benefit in adults but also risks. My baby was 8 pounds; what would this do to her.
My husband and I deliberated but the decision made itself in the end. She fell asleep early and missed a few evening Zantac doses. She slept in a few mornings and missed her morning dose. She didn’t worsen so I stopped giving her the medication and was amazed to see she was fine. We were lucky; she outgrew her reflux quickly. I am confident she had it and that Zantac helped but nothing made me happier than not having to think about the Prevacid.
Those few days when we were trying to decide, I scoured the literature and baby boards, talked to pediatric gastroenterologists, pediatricians, and pediatric ENTs. The picture is definitely not black and white. PPIs are only recently being prescribed to infants which means side effects are not yet known. Mothers swear by Prevacid for their babies and are equally adamant that stopping the medication results in a wailing baby. However, a 2011 meta-analysis was published in Pediatrics (the official journal of the American Academy of Pediatrics). This study showed that PPIs are “not effective in reducing GERD symptoms in infants.”1 Further “evidence supporting the safety of PPIs is lacking.”
Pediatricians are no different than other physicians; we want to give patients something to ease the patient’s concerns. Some patients only feel they are being heard and cared for when they leave with a prescription. It’s part of the reason antibiotics are so overprescribed (a topic for another blog post). It is hard to tell a patient to just wait. There’s a reason that “Take two of these and call me in the morning” is considered classic doctor-speak, not “Just wait a few days and call me.”
I cannot say what I would’ve done if my daughter hadn’t improved so quickly. I probably wouldn’t have given her the Preavcid; the lack of data proving a benefit or establishing safety is concerning. I can’t speak to the observation of hundreds of mothers who see a real benefit to these drugs. Like so much in medicine, there are vagaries and gray areas that we can’t explain. All we can do is take the time to listen to our patients, our doctors, our friends and, most importantly, our instincts.
1. van der Pol et al. Efficacy of Proton-Pump Inhibitors in Children with Gastroesophageal Reflux Disease: A Systematic Review. Pediatrics 2011; 127; 925.