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Managing infants with GERD.

After reading the article about a study of antacid use in babies for the treatment of gastroesophageal reflux disease ("Antacid Use. In infants, it's linked to increased fracture risk," July 2017, page 1), I would like to provide some feedback.

For several years, my prescribing habits for antacids have definitely gone down for both formula-fed and breastfed babies by initiating the use of probiotics for them. If moms are breastfeeding, I encourage them to take probiotics as well. I strongly recommend they minimize dairy consumption, and also suggest no cow's or goat's milk at all while breastfeeding. Also, I tell them to use moderation when consuming other foods--such as nuts and soy--that might trigger ill symptoms in babies' guts. With formula-fed babies or breastfeeding moms who are supplementing with formula, I recommend a whey-based formula such as Goodstart. If infants consuming formula develop symptoms suggestive of gastroesophageal reflux disease (GERD), I switch them to a typical hypoallergenic formula first, proceeding to EleCare or Neocate if necessary.

Even though this approach has been positive, being on the front line, the need for antacids is definitely still present. Although this is an important study, I do think it's going to encourage more pediatricians to refer patients to gastroenterologists for a condition that can and should be easily treated by a primary care doctor. I try my best not to use drugs at all in practice. However, when I see a family or a mom on the brink of postpartum depression, exhaustion, and defeat from a baby who has colic/ GERD--or as I like to call it--"angry bowel syndrome" symptoms, I would rather try utilizing medication than making moms and babies wait for several weeks to sometimes months to actually secure an appointment with a specialist. Furthermore, it's time consuming and extremely expensive for families.

I believe it is important to see a family for follow-up after initiating the medicine. It is obvious to me when the medication is working because I see a happy mom with a baby who is comfortable lying on his back, belly soft, easily comforted, and, if age appropriate, smiling. The baby is sleeping longer, feeding less frequently, and not needing to be held 24 hours a day. His arching is gone, his congestion is improved, choking is gone, and if he did have spitting as a symptom, this has improved as well. I truly believe that, if we ignore baby's symptoms, telling moms the baby will "grow out of it" because of fear of prescribing antacids, or if we delay treatment waiting for a specialist, the baby will be at risk of developing oral aversions and other feeding intolerances. The baby likely will be more prone to ear infections, large tonsils, and a multitude of other aerodigestive issues.

There is an Arizona-based nonprofit called Feeding Matters. I suggest you check out the website: www. feedingmatters.org. The organization's feeding experts have done a great job in creating a survey for moms to help guide them when deciding if their newborns' behavior and feeding patterns are typical or if there might be an existing problem. This organization evolved from many moms seeking assistance with their kids' feeding issues. They quickly discovered a commonality amongst their kiddos: undiagnosed and, therefore, untreated GERD.

Also, the study did not break down breastfed versus formula-fed babies. When studies are done evaluating anything in pediatrics, I truly believe this element always should be included. With this study in particular, pointing at antacid's negative impact on absorption and / or demineralization of bones, one would think this element would be extremely important. The nutrients in breast milk are much more bioavailable compared with formula. Therefore, did this protect against the fracture risks associated with the use of antacids? Did patients who were breastfed need to use antacids for a shorter length of time? Were the doses smaller in babies who were breastfed? Etc., etc.

Finally, it would be nice to know what percentage of term infants with no significant comorbidities were included in the study because this is the population of patients for which primary care doctors are the most likely to the prescribe medications.

Kristin Struble, MD

Phoenix

Editor's note: The study investigators appreciate Dr. Struble's clinical suggestions for practice in treating infants with symptoms that might he suggestive of GERD, hut prefer to hold responses to her questions about the study until their paper is formally published.
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Title Annotation:LETTERS
Author:Struble, Kristin
Publication:Pediatric News
Article Type:Letter to the editor
Date:Sep 1, 2017
Words:735
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