Are Reflux Medications DANGEROUS for infants? (What are the RISKS of PPI use in INFANTS!)

SO you have a child that vomits a lot, and you have recently been given some medications (PPI's in this case) to help with this.
Are there risks with taking these medications? Is there a benefit?
Have a watch to find out!
REFS:
1. Tighe M, Afzal NA, Bevan A, Hayen A, Munro A, Beattie RM. Pharmacological treatment of children with gastro-oesophageal reflux. Cochrane Database Syst Rev. 2014;2014(11). doi:10.1002/14651858.CD008550.pub2
2. Davidson G, Wenzl TG, Thomson M, et al. Efficacy and safety of once-daily esomeprazole for the treatment of gastroesophageal reflux disease in neonatal patients. J Pediatr. 2013;163(3). doi:10.1016/j.jpeds.2013.05.007
3. Van Der Pol RJ, Smits MJ, Van Wijk MP, Omari TI, Tabbers MM, Benning MA. Efficacy of proton-pump inhibitors in children with gastroesophageal reflux disease: A systematic review. Pediatrics. 2011;127(5):925-935. doi:10.1542/peds.2010-2719
4. Brusselaers N, Engstrand L, Lagergren J. Maintenance proton pump inhibition therapy and risk of oesophageal cancer. Cancer Epidemiol. 2018;53:172-177. doi:10.1016/j.canep.2018.02.004
5. Ciciora SL, Woodley FW. Optimizing the Use of Medications and Other Therapies in Infant Gastroesophageal Reflux. Pediatr Drugs. 2018;20(6):523-537. doi:10.1007/s40272-018-0311-3
6. Do not routinely treat gastroesophageal reflux disease (GORD) in infants with acid suppression therapy. - Choosing wisely. www.choosingwi.... Accessed February 6, 2021.
7. Kids Health Information : Reflux (GOR) and GORD. www.rch.org.au.... Accessed February 6, 2021.
8. Clinical Practice Guidelines : Gastrooesophageal reflux disease in infants. www.rch.org.au.... Accessed February 6, 2021.
9. RACGP - Feed thickener for infant reflux. www.racgp.org..... Accessed February 6, 2021.
10. RACGP - Gastro-oesophageal reflux in children - what’s the worry? www.racgp.org..... Accessed February 6, 2021.
11. Smith CH, Israel DM, Schreiber R, Goldman RD. Proton pump inhibitors for irritable infants. Can Fam Physician. 2013;59(2):156. www.pretx.org. Accessed February 6, 2021.
12. Rosen R, Vandenplas Y, Singendonk M, et al. Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. JPGN. 2018;66:516-554. doi:10.1097/MPG.0000000000001889
13. Leung AKC, Hon KL. Gastroesophageal reflux in children: An updated review. Drugs Context. 2019;8. doi:10.7573/dic.212591
14. Orenstein SR, Hassall E, Furmaga-Jablonska W, Atkinson S, Raanan M. Multicenter, Double-Blind, Randomized, Placebo-Controlled Trial Assessing the Efficacy and Safety of Proton Pump Inhibitor Lansoprazole in Infants with Symptoms of Gastroesophageal Reflux Disease. J Pediatr. 2009;154(4). doi:10.1016/j.jpeds.2008.09.054
15. Wang Y-H, Wintzell V, Ludvigsson JF, Svanström H, Pasternak B. Association Between Proton Pump Inhibitor Use and Risk of Asthma in Children. JAMA Pediatr. February 2021. doi:10.1001/jamapediatrics.2020.5710
16. Mitre E, Susi A, Kropp LE, Schwartz DJ, Gorman GH, Nylund CM. Association between use of acid-suppressive medications and antibiotics during infancy and allergic diseases in early childhood. JAMA Pediatr. 2018;172(6). doi:10.1001/jamapediatrics.2018.0315

[@misscd7777]

How would you suggest getting a 6 month old off a does of 5mg? I tried going to 3 mg for 3 days and symptoms came back.

[@AskDrChristian]

Hi there and thank you for your question.
First up the disclaimer: dosage and prescription changes are outside of my scope of practice; these really need to be discussed with your health practitioner who provided them in the first place.
BUT. The question is what you are on and why. If for unsettled behaviour (as I see being done far too frequently), then you should be stopping immediately as reflux medications are not for this, nor do they help.
If your bub is experiencing reflux, there are three possibilities:
1. Reflux is their normal. About 20% of babies experience "physiological reflux", by which their muscles are not quite developed to keep stomach stuff down. This is less likely in a 6MO as they should have developed by this age.
2. They are experiencing a reaction to something they are eating, in which case you would need to be reviewing your/your bub's diet. Biggest culprit here is dairy, which may require a full month of exclusion to see any changes. I'd say almost half of the babies with reflux have this going on.
3. They have a control issue - meaning there is something going on with the control over the vagus nerve and its action on stomach sphincters. The biggest cause I see for this is a problem in the neck. Would be worth getting a musculoskeletal review by osteo/physio/chiro/health practitioner along those lines to assess for this.
#2 and #3 would both fit your child's presentation of regression with reduction in dosing, so it would be worth investigating further!
Let me know how you go, and if you want to discuss more privately, email askdrchristian @ gmail.com
Thanks,
Christian

[@misscd7777]

@@AskDrChristian thanks for the reply!
Yes so he has CMPI and just discovered he is allergic to eggs. He is EBF and I have eliminated both dairy and eggs. Dairy free for over 4 months now. Hoping that now with being egg free his symptoms will get better when I try weaning again. I will for sure email you! He also does go to Chiro :)

[@Jattz89]

@@misscd7777 How did you bub do with weaning off? What worked, what didnt?