Pediatrics

GERD in infants and children

Lately, I have been seeing many infants and children on proton-pump-inhibitors for GERD – or gastro-esophageal reflux disease, which causes acid reflux or heart burn.

Recently, an article in the CBC featuring a pediatrician states that medical Doctors are over-prescribing these medications in what may be normal physiology  http://www.cbc.ca/news/health/story/2011/10/20/baby-cry-spit-up-acid-reflux.html

I do agree with this pediatrician, and do feel that many medications are prescribed too quickly. The good practice of medicine is to investigate, and to determine what exactly is happening. This, in my experience, takes a little time and probing.

The gastro-intestinal tract is not fully developed until 6 months (and may even take longer). This means the nervous system responsible for gut motility, and the mucosal lining of the GI tract (protecting against virus, bacteria, and immune system reactions) is not fully in tact. Breastmilk, which contains high amounts of IgA that is found in mucosal lining, replaces what is not fully formed in an infant.

Not all babies develop at an ‘expected’ time, and it is important not to force their system if it is not responding in a healthy way when you begin to implement changes.

Going back to GERD – we still need to get to the root of the problem. Is it a ‘lazy’ sphincter, or is it a histamine reaction causing excess acid from an allergy to something previously given, like a new food, a component in a vaccine, etc… Is it an ulcer (unlikely in children, in my opinion, but would need to rule out H.pylori)? Is there reduced gastric motiltity in general, or a blockage further down that is impending timely digestion, and thus causing reflux? A nervous child, affecting the nervous system thus slowing down digestion? Acid in the stomach is very important in order to breakdown food to its component parts so it can properly enter the intestines, where nutrients are then taken up in the bloodstream, or get digested down to the colon.

In the majority of cases, GERD will get better as the child grows and matures.

If the discomfort persists, there are many alternatives and other gentler possible solutions to managing GERD and healing inflammation before resorting to medication (which need to be metabolized by the liver, albeit proven to be safe), and stopping acid production all-together.

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