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2012 Buzz Guide: Health

The new controversy in baby medicine

To treat or not to treat “colic”—that is the question for 2012, according to pediatrician JJ Levenstein, co-founder of MD Moms.
 
A recent NPR story examined the marked increase in use of prescription medications for acid reflux in babies. Historically, babies who wail and cry in pain consistently during the first few months of life have been labeled “colicky.” But over the last several years, those who care for infants began to realize that some painful crying may stem from intolerance to proteins present in either breast milk or infant formula. With a change in mom’s diet (by eliminating proteins such as dairy, soy, or wheat) or a switch to formula free of milk, soy, and other large proteins, many babies found relief (and so did their parents).
 
Almost all babies spit up. But a small percentage of babies who spit up have GERD (gastroesophageal reflux disease). These babies, unlike the happy spitters who gain weight and thrive, are unhappy 24/7, may not gain weight, and may even develop inflammation and erosions in the esophagus.
 
Doctors began to use agents such as oral antacids, ranitidine (Zantac), and most recently, proton-pump inhibitors like Prevacid in efforts to soothe these babies. Despite the fact that convincing studies looking directly at their efficacy aren’t available, anecdotally some babies have responded well. As a result, there has been a 16-fold increase in Prevacid prescriptions written for babies in recent years.
 
Should every spitty baby take reflux medication? The answer is, No! The choice to medicate a baby should always be made with great care, and with the full understanding that the benefits of doing so should far outweigh the risks. The number of “colicky” babies we diagnose now are far fewer since we have worked in earnest to adjust diets and identify those babies who truly may benefit from GERD medications. However, if your young infant appears to be absolutely uncomfortable with feeding, is demonstrating behaviors that may implicate reflux or breast milk or formula intolerance, do speak with your healthcare provider about interventions that may make a difference. The good news is that with maturation and time, the majority of babies will outgrow these conditions, and peace will be restored in their bellies (and your home).