Most babies and young children spit up after feeding, but it can sometimes be more than just infant reflux. However, doctors from Seattle Children’s Hospital question whether surgeons are too quick to intervene – especially for infants under 2 months of age.
Reflux is no cause for alarm in itself if the infant is thriving and gaining weight. But if the baby spits up green or yellow liquid, blood, or a mixture that looks like coffee grounds, it may be a sign of gastroesophageal reflux disease (GERD).
GERD is taken more seriously, as the reflux contains more stomach acid and can cause damage to a child’s esophagus, according to the Mayo Clinic.
In a study published today in JAMA Surgery, Dr. Jarod MacAteer and colleagues from Seattle Children’s Hospital suggest that as symptoms of GERD significantly decrease as children grow, antireflux procedures (ARPs) may not be the best course of action for the majority of very tiny babies.
In a retrospective cohort study using data from 41 US children’s hospitals, the researchers identified 141,190 patients who met the study criteria – being younger than 18 years and discharged from hospital for treatment of GERD between the period January 1, 2002, and December 31, 2010.
During the study period, the researchers found that of the 11,621 patients who underwent ARPs, more than half were aged 6 months or under. It was also noted that the time spent in the hospital was significantly longer for the younger patients – 70.5 days for patients under 2 months, compared with 15.6 days for patients aged 5-17 years.
The study acknowledges the difficulty in distinguishing between cases of true GERD, which might ultimately need surgery, and those that might spontaneously resolve themselves as the infant reaches 1-year-old.
The researchers also point out that management of treatment is not consistent with very young infants. They say:
“Ideal management of GERD is a multistep process beginning with an objective diagnosis of pathologic reflux, followed by a trial of validated medical therapy and culminating in an informed decision to offer surgical treatment to appropriate candidates in whom conservative management fails. The degree to which this process occurs in the management of childhood GERD is unclear.”
Diagnosis in nonverbal populations is always complicated, but the study shows that the use of objective tests, such as upper gastrointestinal tract fluoroscopy, may not always be used. The results show that health care providers are “more likely to offer ARP to infants relative to older children.”
The researchers also note that the frequency of surgical intervention suggests that “many infants are likely never given an adequate trial of medical management.”
And the study notes that ARP may not even solve the problem:
“The implications of inappropriate use of ARP in infants are significant, with other studies suggesting that success rates may be lower and recurrence rates higher among these patients.”
The researchers argue that the threshold to perform ARPs seems lower in young babies and that, in spite of guidelines calling for the use of objective tests before surgical intervention, “a standardized evaluation is not common practice.”
The study concludes:
“Given what this study shows regarding the current state of practice at tertiary pediatric hospitals, a greater effort is needed to develop and disseminate best-practice standards for the diagnosis and treatment of children, especially infants, with possible GERD. We must clarify the indications for ARP and clarify its use to treat GERD vs. its use as an adjunct to a durable long-term feeding plan.”
Medical News Today reported how previous research has questioned the presence of disease in infants suffering reflux, again suggesting that health care professionals may be too quick to diagnose the condition.