Babies, Reflux and the Problem with PPIs

Infantile reflux is challenging, for everyone involved. The symptoms of infantile gastro-oesophageal reflux ("reflux") are often nonspecific, and vary widely (from regurgitation, to coughing, to fussing/refusing to eat, to excessive crying). In rare cases, reflux can cause severe complications, such as failure to thrive, so do seek help if you’re concerned about your little one.BUT… please know that reflux is actually common in babies.In fact, up to 65% of infants regurgitate stomach contents at least once a day between 3-6 months. And, in most cases, 'reflux' spontaneously resolves, with complete resolution in 95% of babies by the time they're 12 months old (1, 2).Even though reflux is considered a relatively common and normal event, protein pump inhibitors (PPIs), which suppress acid secretion in the stomach, are still very often prescribed (1). In fact, they’re one of the most widely used drugs in the world (3). While this can provide symptomatic relief if some cases, PPIs should not be used long-term.The Problem with PPIsIn adults, PPIs have been associated with increased risks of gastrointestinal and respiratory tract infections, Vitamin B₁₂ deficiency, Magnesium deficiency, bone fractures, chronic kidney disease, cognitive decline, and rebound hyperacidity after discontinuation (3). PPIs can also cause imbalances of the all-important microbiome.Given how immature an infant’s digestive system is, and how serious some of these side effects are in adult populations, the use of PPIs in infants is worrisome.

What does the research show regarding the use of PPIs for infantile reflux?“PPIs should be used only after nonpharmacological measures have been taken with incomplete success” (1)“Clinical trials show that PPI treatment is not effective for reflux symptoms in infants and there is insufficient evidence of their use” (1)“PPIs are not effective in reducing GERD symptoms in infants” (2)“If the primary aim is to treat GERD symptoms in infants, PPIs should not be prescribed” (2)

This begs the question, what else can be done? Here are some of my recommendations:

1. Remember that fussiness and reflux is both common and normal for a young baby.
2. If you’re breastfeeding, consider a short-term elimination diet, which has been shown significantly reduce symptoms of reflux and colic (4). Some of the most likely dietary irritants for babies are cow’s milk products, soy, wheat, corn, eggs, and peanuts. Other foods which should be minimised are alcohol, cabbage/broccoli, soft drinks, spicy foods, peppermint, canned foods and coffee. If you think your baby is reacting to a particular food, eliminate that food from your diet for 2-3 weeks and monitor symptoms (food diaries are helpful if your memory declines with sleepless nights like mine does!). Generally, if food is an irritant for your little one, their symptoms will begin to improve within 5-7 days after elimination (but some take more time, and some will take less).
3. See a lactation consultant to ensure your little one is latching properly and burping sufficiently, or call on the wonderful support that the Australian Breastfeeding Association offers.
4. Hold your baby upright for about 30 minutes after each feed.
5. If your baby is formula-fed, consider changing formulas (to a lactose/dairy-free formula)
6. Consider infant-specific probiotics (see a qualified Naturopath to ensure correct strains are given).
7. Consider seeing a qualified paediatric chiropractor or osteopath to help with structural alignment and correct nappy changing technique!
8. Try a warm bath, or baby massage with a few drops of lavender essential oil.
9. Depending on the age of the baby, herbal teas (fennal/chamomile) are great. Slippery elm powder is another option for older babies.

Often, if the mum is breastfeeding, I’ll also support her using specific strains of probiotics and carminative herbal medicines that are safe during lactation (such as chamomile and lemon balm).