When the Pediatrician Says "GER"
|When the Pediatrician Says "GER"|
During her pregnancy, Sarina ate all the right things, attended maternity yoga classes, and perused a nice stack of parenting books, but she was unprepared for what lay ahead.
She and Garrett bragged about how peaceful their newborn daughter was but their bubble soon burst. Within weeks their baby was crying inconsolably several times a day, sleeping poorly and waking with screams, spitting up, fussing at the breast, and experiencing occasional watery stools.
Advice came from all directions. Sarina heard about gassy foods and gave up broccoli. They tried some drops for gas, constant carrying, classical music, and even a vibrating chair but nothing brought any relief to their daughter or to their own wired nerves and baggy, bloodshot eyes. The doctor assured them there was nothing wrong with their baby.
In tears herself, Sarina tried telling her story to another pediatrician and was told her baby had GER, or gastroesophageal reflux. They were sent home with drug samples and a prescription and told to elevate the head of the baby’s bed. They were not the kind to rely on drugs, but Garrett worried that their baby might be permanently harmed somehow if they did not provide the medications. At the end of their rope and eager to see some relief for their daughter, they gave the drugs a try, but they saw no improvement. The doctor told them to give the medications some time to work and added a second drug. Sarina and Garrett then thought they might have seen a little improvement in their daughter but it surely wasn’t enough for any of them.
While the names and details have been changed, this story is based on an actual case study.
Whether they believe in natural living or not, more and more parents are hearing the diagnosis of reflux or GER and being sent home, perplexed, with an array of medications and a few odd pieces of advice. Do they help?
It used to be that when a baby displayed excessive crying the diagnosis was colic. What does colic mean? It means the child cries a lot. This vague diagnosis did not lead parents to helpful answers. Today, most of these crying babies are given a diagnosis that has escalated incredibly over the last decade: GER (reflux), or GERD, standing for gastroesophageal reflux disease. Think heartburn. These diagnoses imply that the child is experiencing surges of acid from the stomach up into the throat.
Actually, a weak lower esophageal sphincter that allows some acid to regurgitate is rather normal in young babies, as is spitting up. Studies suggest that 50 to 67% of young infants have gastric reflux symptoms. This can hardly be called a disorder. Still, one should try to address the needs of a baby who is frequently exhibiting distressed crying and other worrisome symptoms. Earlier literature reports 10 to 30% of babies as suffering from colic. This is about the number of babies given a diagnosis of reflux today, based on the same symptoms. Whether either of these diagnoses leads to effective resolution is questionable.
The initial diagnosis of GER is usually made simply on the parents’ description of symptoms such as frequent crying, irritability, appearance of pain, poor sleep, arching back, spitting-up, chronic sinus congestion, or frequent ear infections. Then the “disease” GERD is suggested based on further symptoms such as fussy eating, gagging, sinus infections, red throat, breathing problems, or poor weight gain.
The ever-growing popularity of these diagnoses developed along with the popularization of relatively new drugs for gastric acid reflux; various new proton pump inhibitor (PPI) drugs such as Prilosec and Prevacid. Currently, hundreds of thousands of babies and toddlers are prescribed expensive PPI drugs each year in the United States (a total of 2 million children up to the age of 16).
The main concern with true, excessive reflux is that there can be severe repercussions from mucus membranes being chronically “burned” by stomach acid. Anemia can develop as well due to blood loss from bleeding tissues. The medical paradigm is that acid-blocking drugs are beneficial in serious cases to prevent further consequences. The term GERD is assumed by most to represent these extreme cases that may warrant medication. Authoritative sources report only 1 in 300 babies as actually having GERD. This sounds more reasonable, but the number of babies prescribed drugs for reflux is 10 to 15 times this amount.
Some parents report gradual improvement in their infants on PPIs over time. Of course, a majority of babies naturally outgrow colic/GER symptoms during their first year whether medicated or not. Sudden withdrawal from acid-blocking drugs can cause symptoms in any person as the body adjusts to regular acid reduction by creating greater amounts of acid. An increase of symptoms upon removal of the drug does not necessarily prove it was helping.
More often, parents find that PPI drugs provide little, if any, help. Multiple studies performed by these very drug manufacturers support this observation.
Current studies reveal that there is great randomness to the symptoms used to diagnose GER,1 meaning that true diagnosis is rather ambiguous. Additionally, there is little correlation found between symptoms and the gold standard of esophagus examinations: endoscopy and biopsy.2 Furthermore, there is little correlation found between these two tests. Even measuring a child’s response to PPI drugs does not correlate to a diagnosis of GER; their response does not correspond to the amount of acid measured in their esophagus.3
It has also been shown that while the drugs reduce acid in the stomach and esophagus, they do not reduce baby’s colic symptoms or other symptoms that initially lead parents to seek treatment4—so does the acid really need reducing? GER drugs increase pneumonia5 and triple the risk of gastrointestinal infections6, while long-term safety tests are nonexistent. Other side effects of PPI drugs include headache, constipation, vomiting, stomach pain, and rashes. Absorption of nutrients is reduced, and prolonged use can lead to osteoporosis. Additionally, a systematic review of PPI studies in treatment of reflux determines that they provide no more benefit than placebos.7