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Study: Over-Diagnosis of Reflux in Infants Leads to Needless Medication

Calling infant reflux a disease increases parents’ wish for medication (Apr. 1)

Drugs used to treat gastroesophageal reflux disease (GERD) are some of the most widely used medications in children less than 1 year old. But in a new study, researchers at the University of Michigan and the University of Missouri have concluded that physicians often label common symptoms in infants, such as crying and spitting up, as disease. Frequent use of the “GERD” label can lead to overuse of medications in infants, the new research shows.

The study — published online in Pediatrics — found that doctors’ use of the GERD label prompted parents to request medications for their babies even when they had been advised that the drugs would probably be ineffective, according to senior author Beth Tarini, MD, assistant professor of pediatrics at the University of Michigan’s C.S. Mott Children’s Hospital.

“As doctors, we need to appreciate that the words we use when talking with patients and parents have power — the power to make a normal process seem like a disease. As pediatricians, our job is to make sick children healthy, not to make healthy children sick,” Tarini said.

In the study, researchers surveyed parents in a pediatric clinic in Michigan about how they would respond to a hypothetical clinical scenario involving an infant who cries and spits up excessively but is otherwise healthy.

The parents were randomly assigned to receive one of several vignettes. In some vignettes, the physician gave a diagnosis of GERD; in others, the physician did not provide a disease label. In addition, half of the parents were told that existing medications are probably ineffective; the rest were not given information about medication effectiveness.

Parents who received a GERD diagnosis were interested in medicating their infant, even when they were told that the drugs would be ineffective. Parents not given a disease label were interested in a prescription only when the doctor did not discuss whether the medication was effective.

Over-diagnosis of GERD can make a medical condition out of normal behavior, says lead author Dr. Laura Scherer.

“The growing digestive system of an infant can be finicky and can cause the child to regurgitate. The discomfort can cause the infant to cry, but it is not necessarily a disease,” Scherer says. “Parents can learn from this study that a disease label can make them want medication for their child, regardless of whether the drugs are effective or not. Parents should follow doctors’ advice, which sometimes means accepting a doctor’s explanation of why an infant’s crying and vomiting may be normal."

“Unnecessary use of medication is costly,” Scherer adds. “Especially for families without insurance, the over-use of medications can be a needless expense. In addition, the long-term side effects of the medication frequently prescribed to children diagnosed with GERD have not been fully studied, although the medication has been correlated to slightly higher rates of pneumonia.”

Sources: C.S. Mott Children’s Hospital; April 1, 2013; and Pediatrics; April 1, 2013.

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