What's In A Name? More Drugs For Babies If It's GERD

NPR icon by Katherine Hobson
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Say your one-month-old baby is spitting up and crying a lot. Your usual bag of infant-soothing tricks hasn't worked, and you're worried that there's something wrong with her.

So you head to the pediatrician, who tells you that your otherwise healthy child has gastroesophageal reflux disease, or GERD. Would receiving this medical diagnosis make you more interested in giving her drugs than if you never heard the word "disease"?

Yes, according to research published online Monday in Pediatrics.

Researchers asked 175 parents visiting a pediatric clinic in Michigan about how they would respond to one of four hypothetical scenarios about a crying, regurgitating baby. Everyone got the same basic description of what was happening, but some parents were told that the child had GERD while others heard no mention of a disease. In addition, half were told that the drug wasn't likely going to help the symptoms,while the rest were not given any information on effectiveness.

Parents who had the GERD label applied to the infant's symptoms were more likely to be interested in drugs even when they were specifically told that they probably wouldn't work.

"It's important for both patients and doctors to know the powers that these labels have," says Laura Scherer, an author of the study and an assistant professor of psychology at the University of Missouri.

The authors used GERD in their scenario because there's concern that it is being overdiagnosed and overtreated with medications including proton pump inhibitors in babies. Prescriptions to treat GERD are on the rise, but there's no evidence that they help infants who are just fussy and spitting up a lot. (The drugs might help severe cases confirmed by endoscopy, the authors said.)

Part of the problem may be confusion about the difference between normal spitting up and GERD, which is a more serious problem involving acidic reflux that damages the lining of the esophagus. Spitting up can be a symptom, but GERD has to be confirmed by endoscopy, the authors said.

Frequent spitting up affects about half of babies under six months and is the result of an inefficient valve at the top of the stomach, says William Carey, a clinical professor of pediatrics at the Children's Hospital of Philadelphia, who wrote a commentary accompanying the study. "It's almost always completely benign and goes away spontaneously," usually between six and 12 months of age, he says.

In addition to concern over babies being unnecessarily medicated, labeling a child as sick can make parents worry long after the symptoms have ceased, he says. There can be "an enduring unease about the possibility that the child is not entirely alright," he says.

Parents should "look beyond the label and listen to all the information that the doctor is telling you" about the condition and possible treatments, says Scherer.

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