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Reassurance can help new parents of frequent ‘spillers’

NEW ORLEANS — For most infants, spitting up, or “spilling,” is a way of life, not a disease, according to a speaker here at the 2012 AAP National Conference and Exhibition.

Eric Hassall, MD, of Sutter Pacific Medical Foundation in San Francisco, said there are a range of approaches for parents who are concerned their babies have “acid reflux,” but may only be frequent spillers.

The first approach, he said, is reassurance.

“It’s often not the frequency of the spitting up that is bothering them, it’s the baby’s irritability,” Hassall said, noting that educating the parent about positioning, burping, eliminating exposure to smoke and changing formulas can all provide reassurance to a frustrated parent. Other advice includes trying smaller, more frequent feedings and, possibly, thickening formulas.

“As a last ditch, prescribe,” he said. “If you do prescribe an acid-suppressing medication, start off with an H2-blocker.”

The two major pharmacotherapies used in infants and children are H2-blockers and proton pump inhibitors, both of which have been used safely in children, Hassall said.

H2-blockers have been used extensively in infants and are considered safe, but have been shown in studies to be associated with some adverse events, including diarrhea and abdominal pain. Proton pump inhibitors have also been shown to be safe, but have risks as well, he said, citing reports in the literature of necrotizing enterocolitis and other adverse events.

“The risk is not prescription, it is over-prescription,” Hassall said.

It is important to consider the difference between gastroesophageal reflux, which is normal and almost always goes away by the time a child reaches toddler age, and gastroesophageal reflux disease, which occurs when complications from gastroesophageal reflux arise, such as failure to gain weight or esophagitis, he said.

Published literature defines gastroesophageal reflux disease as present in pediatric patients “when reflux of gastric contents is the cause of troublesome symptoms and or complications, but the question remains — is troublesome for whom,” Hassall said, eliciting laughs in the audience. He added that diagnosis can be difficult in infants because, unlike adults or older children, infants cannot describe their symptoms.

“When you have a surrogate reporter of information, like the parent, if it is troublesome for the parent, it doesn’t necessarily mean it is reflux disease,” Hassall said.

For more information:

Hassall E. Session D3068. Presented at: AAP National Conference and Exhibition; Oct. 20-23, 2012; New Orleans.

Disclosure: Hassall reported no relevant financial disclosures.