Formal “GERD” label from doctors makes parents more interested in medicating infants

Today's guest blogger David M. Pollack, M.D., is a pediatrician practicing at The Children’s Hospital of Philadelphia Care Network. He sees patients at CHOP Primary Care offices in Broomall, Drexel Hill and Media.

Simply labeling an otherwise healthy infant as having a “disease” made parents more interested in giving their child medication, even when they were told drugs might be ineffective, according to a study in the May 2013 issue of Pediatrics published online today.

In the study, the authors concluded that disease labels, such as GERD (gastroesophageal reflux disease), and information about a medication’s relative effectiveness may strongly influence parents’ interest in using one. There is a growing concern that GERD is over-diagnosed and over-treated in infants, and the authors suggest that physicians can reduce interest in medications by not labeling the symptoms as GERD, but rather by explaining to parents that acid reflux medications may often not be as effective as promised.

GERD has received a great deal of attention in the news in parenting magazines, websites and online web forums. As a result, the potential diagnosis of GERD is often first raised by parents themselves even before I have had the chance to hear about the baby’s symptoms or reach a conclusion on my own. This is just one example of how pediatrics has dramatically changed during my 30 years of practice, as it relates to the explosion of available information, importance of clear communication, and my growing responsibility to help families navigate safely through it all.

As a pediatrician I believe it is important to:

  1. Think Holistically. If a problem can be solved without medication, try that first.
  2. The younger the infant, the less inclined we should be to use medications, if at all possible.
  3. Offer parents as much relevant information about an issue, but use words and phrases to help them make the most sensible decision for their child.

What parents should look for – indications of GERD

Although there are some sophisticated and invasive ways of formally diagnosing GERD in infants, for the most part the “label” is used solely based upon clinical criteria alone, usually from a parent’s description of symptoms, sometimes with a bit of help from the physical exam. Here are three symptoms that might point to a formal diagnosis of GERD:

  1. Excessive irritability. Of course this is subjective, and I try to have parents understand that a certain amount of crying and fussiness is normal during the day for every baby. Having them quantitate how many hours out of a 24 hour day are filled with severe discomfort for their infant helps me decide that treatment may be warranted
  2. Poor weight gain. Not all babies who are diagnosed with GERD have excessive vomiting, but if it is present, it may lead to poor weight gain, which could be an indication for treatment. In addition, some GERD babies feed poorly due to discomfort, another possible reason for failing to thrive and the need for medication.
  3. Respiratory Symptoms. Some babies with GERD may actually aspirate some of their feeding into the lungs or upper airways, which may lead to otherwise unexplained chronic coughing, wheezing and overall breathing difficulties, especially at bedtime. Such symptoms may resolve when treated effectively.

And so as the article points out, if your pediatrician believes that your infant may be a candidate for medication for one of these reasons, it makes sense to use the term “GERD” and explore the use of medication. But, if your baby’s symptoms and exam do not point in this direction, it’s important to focus on the big picture – while your infant might spit up and appear “cranky”, he or she is growing properly and a certain level of fussiness is normal for all babies.

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