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'GERD' label for infant fussiness leads to unnecessary treatment, study finds

'GERD' label for infant fussiness leads to unnecessary treatment
Tricia Banks/Creative Commons
Research has shown that PPIs are no more effective than placebos in relieving unexplained crying, irritability and spitting up in babies under a year old.

When a healthy baby’s spitting up and crying are labeled by a doctor as symptoms of gastroesophageal reflux disease (GERD), parents become eager to give the baby medications, even when they are also told the medications are unlikely to be effective, according to a new study from researchers at the University of Michigan and the University of Missouri.

The study’s findings underscore how the medicalization of ordinary behaviors can lead to unnecessary and even harmful treatments.

This study, published Monday in the journal Pediatrics, was undertaken, say its authors, out of a growing concern that GERD, a condition in which stomach acid flows back (or refluxes) into the esophagus, is being overdiagnosed and overtreated in infants. In recent years, the number of babies treated with acid-suppressing drugs known as proton pump inhibitors (PPIs) has skyrocketed. One study found that between 1999 and 2004 the use of PPIs in infants under the age of 1 year increased sevenfold.

Yet when babies spit up, the refluxed content is rarely acidic. Not surprisingly, therefore, research has shown that PPIs are no more effective than placebos in relieving unexplained crying, irritability and spitting up in babies under a year old — behaviors that are actually quite common and normal in infants. The U.S. Food and Drug Administration does not currently approve PPIs for use in children that young, but that hasn’t stopped doctors from prescribing the drugs “off label.”

Sometimes, of course, it’s the parents who demand the drug for their infant, often after learning about it online or through various advocacy groups.

Study details

For this study, researchers recruited 175 parents (average age: 35) who had made appointments at a University of Michigan pediatrics clinic between May 2011 and February 2012. The parents were randomly assigned to respond to hypothetical scenarios. Each scenario described a fussy infant who cries and spits up excessively, but is otherwise healthy — in other words, developing normally and gaining weight. In one scenario, a doctor gives the baby the GERD “disease” label. In the other, no disease is diagnosed. In half of each of these scenarios, the parents are informed that existing medications would be ineffective for the baby. In the other half, they’re told nothing about the medications’ ineffectiveness.

The parents were mostly women (82 percent), white (59 percent) and highly educated (66 percent had a college degree). Some 37 of them (21 percent) said that one or more of their children had been previously diagnosed with GERD, and 26 said they had given their child medication as a result of that diagnosis.

The researchers found that parents who were presented with the scenario with the GERD diagnosis expressed interest in giving medication to the baby — even when explicitly told the medication was ineffective. This was especially true for parents whose own children had been diagnosed in the past with GERD.

When the baby’s behaviors were not labeled as GERD, the parents were still interested in the medications for the child — but not when the ineffectiveness of the drugs was explained to them.

“These findings lend support for our hypothesis that the use of the GERD label can influence interest in using potentially ineffective medical interventions,” the study’s authors conclude.

Resisting medicalization

"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,” said Dr. Beth Tarini, one of the study’s authors and a pediatrician at the University of Michigan, in a prepared statement that accompanied the study. “As pediatricians, our job is to make sick children healthy, not to make healthy children sick.”

But doctors aren’t the only ones with some responsibility in this and similar situations. It’s also our job as parents — and health consumers — to be alert to the growing and disturbing trend in our culture to turn normal human conditions into disease symptoms that require medical treatment.

As one scholar has put it:

Medicalization isn’t the most elegant noun … but it’s the best one we have for describing how common emotions and traits are turned into treatable conditions. Bad breath becomes halitosis, for example, and impotence erectile dysfunction. Even overdoing plastic surgery gets a brand-new name: body dysmorphic disorder. To put it bluntly, this process of pathologizing has gotten out of control. It’s become a juggernaut that no one seems able to stop.

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