Over-diagnosis of reflux in infants leads to needless medication

Mon Apr 1, 2013 10:30am EDT

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Calling gastroesophageal reflux a disease increases parents' wish for
medication, symptoms are frequently over-treated in infants, according to new

ANN ARBOR, Mich.,  April 1, 2013  /PRNewswire-USNewswire/ -- Medications used to
treat gastroesophageal reflux disease, or GERD, are some of the most widely used
medications in children less than one year old.

But in a new study, researchers from the  University of Michigan  and the 
University of Missouri  concluded that physicians often label common symptoms in
infants, such as crying and spitting up, as disease. Frequent use of the GERD
label can lead to overuse of medication, according to study published today
online ahead of print in the journal  Pediatrics.  

The study found that doctors' use of the label GERD prompted parents to request
medication for their baby even when they had been advised that the medication
would probably be ineffective.  

"As doctors we need to appreciate that the words we use when talking with
patients and parents have power - the power to make a normal process seem like a
disease.  As pediatricians, our job is to make sick children healthy, not to
make healthy children sick," says Tarini, who also is an investigator in U-M's
Child Health Evaluation and Research Unit.

In the study, researchers surveyed parents coming into a pediatric clinic in 
Michigan  about how they would respond to a hypothetical clinical scenario
describing an infant who cries and spits up excessively but is otherwise
healthy. Parents were randomly assigned to receive one of multiple vignettes. In
some vignettes, the doctor gave a diagnosis of GERD; in others the doctor did
not provide a disease label.

Additionally, half the parents were told that existing medications are probably
ineffective; the rest were not given information about medication effectiveness.
Parents who received a GERD diagnosis were interested in medicating their
infant, even when told that medications were ineffective. Parents not given a
disease label were interested in a prescription only when the doctor did not
discuss whether the medication was effective.

Over-diagnosis of GERD can make a medical condition out of a normal behavior,
says lead author  Laura Scherer, assistant professor of psychological science in
the College of Arts and Science at the  University of Missouri.

"The growing digestive systems of an infant can be finicky and cause the child
to regurgitate. The discomfort can cause the infant to cry, but it is not
necessarily a disease," says Scherer. "Parents can learn from this study that a
disease label can make them want medication for their child, regardless of
whether the drugs are effective or not. Parents should follow doctors' advice,
which sometimes means accepting a doctor's explanation of why an infant's crying
and vomiting may be normal."

"Unnecessary use of medication is costly," says Scherer. "Especially for
families without insurance, the over-use of medications can be a needless
expense. In addition, the long-term side effects of the medication frequently
prescribed to children diagnosed with GERD have not been fully studied, although
the medication has been correlated to slightly higher rates of pneumonia."

Additional authors:  Of the  University of Michigan:  Brian J. Zikmund-Fisher,
Ph.D., Department of Health Behavior and Health Education in the School of
Public Health and  Angela Fagerlin, Ph.D. of the Department of Internal Medicine
and co-director of the Center for Bioethics and Social Sciences in Medicine.

Journal reference:www.pediatrics.org/cgi/doi/10.1542/peds.2013-0286

Funding: Dr. Tarini is supported by a K23 Mentored Patient-Oriented Research
Career Development Award from the National Institute for Child Health and Human
Development (K23HD057994). Dr. Zikmund-Fisher was supported by a Mentored
Research Scholar Grant from the American Cancer Society (MRSG-06-130-01-CPPB).
Funded by the National Institutes of Health (NIH).  

About C.S. Mott Children's Hospital:  Since 1903, the  University of Michigan 
has led the way in providing comprehensive, specialized health care for
children. From leading-edge heart surgery that's performed in the womb to
complete emergency care that's there when you need it, families from all over
come to the  University of Michigan  C.S. Mott Children's Hospital for our
pediatric expertise.

More information is available here:  http://mottchildren.org

SOURCE   University of Michigan  C.S. Mott Children's Hospital

Mary F. Masson, mfmasson@umich.edu, or 734-764-2220

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