Why newborns shouldn't be prescribed reflux medications - PPI's
In my private practice where I specialise in remedying the causes of reflux naturally, around three in five newborns have been prescribed acid blockers, known as Proton Pump Inhibitors (PPI’s), or more specifically Omeprazole, Ranitidine, Esomeprazole, or Losec. This is an unexplainable high number considering the facts.
Digest these facts…
The hydrochloric acid (HCL) plays a vital role in immunity by providing an acidic environment (typical pH of 1-2) that it is hard for any invading bacteria or virus to survive. It is a highly necessary component of protection for your baby’s health, preventing unwanted bacterial growth in the stomach and upper intestine and helping them break down the nutrients in their food/milk appropriately. Without it, their bodies stop functioning in a healthy manner.
Research now tells us that ‘there is little evidence that acid plays any role in patterns of unsettledness and irritability in infancy. Furthermore, there is evidence that acid suppression does nothing to improve these distressing behaviours and that PPI therapies are associated with important adverse effects.’ 1
Despite this, the rates of prescribing PPI’s has greatly risen. ‘Over the past 15 years, many thousands of fussy babies worldwide have been given medicine in the belief that their colic was caused by painful acid reflux, Gastroesophageal Reflux (GER). From 1999-2004 the use of a popular class of liquid antacid (PPI’s) in young children increased 16-fold and from 2000-2003 there was a 400% increase in the number of babies treated with anti-reflux medicine. This rate of increase has continued—or accelerated—from 2003 to the present.’ 2
In 2013 omeprazole was the third most commonly dispensed medicine in New Zealand. Between 2006 and 2010 the number of prescriptions dispensed for newborns increased from 4650 to 8231. The largest occurred in the age zero to three months (111%) and four to six months (80%) cohorts. 3
In Partnership Health Primary Health Organisation (PHO), Canterbury, New Zealand, 15% of infants less than one year of age received a prescription for the PPI omeprazole in 2010. Five years earlier in 2005, only 4% of children in this age group were prescribed this drug. 4 I wonder what the number is now? All of these increases are despite FDA regulations.
FDA does not approve PPI’s for newborns
The US Food and Drug Administration (FDA) safety and efficacy guidelines for omeprazole are for the treatment of Gastroesophageal Reflux Disease only (GORD/GERD not GOR/GER – reflux or silent reflux) is for the duration of eight weeks, and are established for ages 2 to 16 years only. Omeprazole is excreted in breast milk and can potentially cause adverse effects in an infant.
Esomeprazole’s safety guidelines state that prescription is only for ages 1 to 17 years or for the short-term use of six weeks for GORD/GERD only.
For ranitidine, the safety and efficacy has been established for the 1 month to 16 year age-group for the treatment of GORD/GERD only and should not be taken any longer than 2 weeks.
Use of PPI’s is detrimental to a newborns health
A study held in 2012 by HEB Pharmacy and the University of Texas on the ‘Safety of Long Term Usage of Proton Pump Inhibitors with Focus on Bone Fracture Risks’, shows evidence that Chronic use of PPI’s, which many of the baby’s that pass through my practice can be classed as having, brings the very real risk of pneumonia and GI infections. PPI use is associated with increased risk of fractures because they decrease the absorption of calcium. When there is a deficiency of calcium, the baby has to leech it from their teeth, bones and muscles causing various forms of weaknesses. Calcium deficiency can lead to high blood pressure, high cholesterol, irregular heartbeat or palpitations, loss of muscle tone, tooth decay, muscle cramps and/or convulsions, colon cancer, osteomalacia (softening of bones), osteoporosis and rickets. Omeprazole has already proved itself to cause bone fractures for adults who have been taking it for a year.
PPI’s also decreases iron, magnesium and vitamin B12 absorption. Iron deficiency, otherwise known as anaemia, brings tiredness, lethargy, shortness of breath, palpitations, dizziness and light-headedness. A deficiency of magnesium for a newborn can lead to a loss of appetite, a failure to grow, impaired development, muscular irritability, hallucinations, mental confusion, generalized weakness and flaccidity in the body. Occasional spasticity and rigidity in the body can also be present as can muscular tremors, twitches, as well as sleep apnoea. A deficiency in B12 will only show itself outwardly when all of a newborn’s reserves of this important vitamin have been used up and babies are already born with a naturally low supply. Non-absorption or low supplies in the first year of life will see your newborn failing to grow normally with signs of anaemia, fatigue and they may not be able to use their muscles effectively. A B12 deficiency also has the potential to cause severe and irreversible damage, especially to the brain and nervous system. It has been found that levels even slightly lower than normal can result in lethargy, being depressed, numbness or tingling in the hands or feet, confusion, irritability and a poor memory.
Why the drugs seem to settle some babies
Some babies do look to settle slightly on the drugs, but the reasons for this come from negative sources – the alcohol in the PPI’s and the side effects of not absorbing necessary nutrients – lethargic, depressed, fatigue, anaemia and mental confusion to name some of these.
What happens when a PPI is stopped?
Acid is vital for the body to function, to protect and to grow to its full potential. The body knows this so it will always begin to produce more acid to fight the PPI, which produces further chemical imbalance in other parts of the digestive system.
When a newborn is weaned off a PPI acid levels spike beyond natural levels which causes heightened unsettledness and in some cases extreme discomfort. If parents reduce the amount without knowing this and without professional help, they understandably think that the drug is working to their baby’s benefit and unfortunately, may place baby back on the PPI.
However, to heal the newborns digestive system and return full acidic health, it is necessary to nurture the baby through the spike before results are witnessed. I offer natural remedies to help newborns and parents through this.
Most babies do not have Gastroesophageal Reflux Disease (GERD) - this is actually quite rare and thorough investigation should be undertaken to determine diagnosis. One of the common signs of GERD is low, to no weight gain – your baby will be failing to thrive while they reflux a lot. Spitting up, Gastroesophageal Reflux (GER) is normal for babies and it doesn’t mean they have a problem that needs medication even if this is happening a lot.
Instead, rebalancing the amount of food they are having to be in accordance with their digestive system can help tremendously, as can checking for a tongue tie and/or, releasing an overload of trapped air - these are the actual causes of GER and the causes I remedy. If your baby has been, or is on PPI's, may I suggest you get their levels of vitamins and iron checked by your doctor.