Reducing the use of proton pump inhibitors in infants with reflux symptoms

Regurgitation is common in the first months of life, and concern of disease often prompts parents to seek medical care and advice. Treatment with proton pump inhibitors is common and increasing, but it is largely unnecessary and not supported by evidence in infancy. This article describes the clinical features that may reflect gastro-oesophageal reflux in infants and guidelines on management, which recommend against routine use of proton pump inhibitors for isolated reflux symptoms in infants.

Gastro-oesophageal reflux in children is defined as the effortless passage of gastric contents to the oesophagus with or without regurgitation or vomiting.1 This is usually physiological, commonly occurs after meals, and is usually without associated symptoms in healthy infants. Daily episodes of regurgitation are particularly common in newborns and infants.2 A review found that up to a quarter of healthy infants under 1 year old were affected by two or more daily episodes of regurgitation lasting more than three weeks.2 The review also found that fussiness and infantile colic were equally prevalent and may consequently overlap with regurgitation.2

Gastro-oesophageal reflux disease (GORD), unlike physiological gastroesophageal reflux, is a pathological process in which reflux events cause persistent or severe symptoms that require treatment or when there are complications as a result of reflux.1 Clinical features that may be seen in infants with GORD include general discomfort or irritability, wheezing, refusing …