And then she saw the news this week about a study published in JAMA Pediatrics about the association between antacids and later development of allergies. She was hoping for a miracle fix for her fussy baby and now is hearing that it may cause food allergies, hay fever, asthma, and even anaphylaxis. She was at a crossroads between the advice she got from friends, the new study results, and a fussy, spitty, often inconsolable baby in front of her (not to mention the lack of sleep!).
We walked through the study results. We discussed what we know about fussy/spitty/colicky infants (nearly all are entirely normal albeit frustrating at times). I told her what to expect in the coming days, the next week, and the next month. I reassured her that no matter what we do today, things will be better in a few weeks. I tolder her that I don’t have a miracle fix and, in fact, from this study I might make more trouble if I try and convince her that I do.
I’ve looked through the study and am impressed with the findings. Here are my three immediate take-aways.
- This study was HUGE & thorough. It followed over 800,000 children. More children gives more weight to studies because it’s easier to see clear associations when we have lots and lots of patients to draw from. It looked at children’s medications and subsequent diagnoses over time. Specifically, it examined antibiotic prescriptions and antacid prescriptions and subsequent diagnoses like asthma, allergies, and eczema.
- The results give me pause. Double the chance of developing food allergy in children given antacids (h2 blockers or PPIs) during the first 6 months of life. Double asthma chance in children given antibiotics in first 6 months of life. Increased risk of medication allergy, allergic rhinitis (hay fever), asthma, anaphylaxis in kids given antacids or antibiotics, as well. The mechanism or cause-effect relationship was not addressed but the association was shown to be significant.
- These medicines are not harmless. I’ve never been a big prescriber of acid suppressing medicines for fussy/spitty/colicky babies. The previous studies I’ve seen haven’t demonstrated much help and in my own practice I don’t see many dramatic changes. I work with parents to avoid these medicines, help parents handle the fussy periods, and know when spitty is normal (nearly always) or a sign of something else going on. To be honest though, I’ve thought of acid suppressing medicines in infants as mostly harmless. I’m changing my tune. I’m going to work harder to only use antacids AND antibiotics when I’m very confident the benefit outweighs the risk.
I love that we are able to look at what we do and adjust as new evidence comes to light. The more we research and learn, the less we do to interfere with the natural history of babyhood. I had previously written about we physicians messed with infant feeding ended up with lots more issues like food allergy and how we have now course corrected. There are so many examples in the last 50 years of pediatric research where we end up doing less and doing better.
As I got up to leave our visit, the baby was still crying. His mother was just as tired. Her shirt still had spit up on the shoulder. She knew she was in for some more rough days and nights. But she left reassured. She left empowered with what she can do to make things as good as they can be for now. She left knowing what to expect in the coming weeks. And she left without a prescription.