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GERD label makes parents more likely to want medicine

By Genevra Pittman

NEW YORK (Reuters Health) - Telling the parents of babies who spit up and cry frequently that their child has gastroesophageal reflux disease, or GERD, makes them more likely to want medicine - even if they're also told it isn't likely to help much, a new study suggests.

Most babies who spit up don't have an acid reflux problem, researchers said, just a not-quite-developed upper stomach valve.

Still, an increasing number of those kids are being labeled as having GERD - even though a definitive diagnosis normally requires an invasive test.

"Roughly 50 percent of babies during the first six months are spitting up enough to bother their parents," said Dr. William Carey from The Children's Hospital of Philadelphia, who wrote a commentary published Monday with the new study.

"I never offered medication for a kid who was just spitting up and gaining weight well and happy," he told Reuters Health. "I could confidently tell the mother, ‘Look, it's going to be a nuisance until about six months, and then it's gradually going to get better.' It's an irritating variation of normal."

For their study, Laura Scherer from the University of Missouri in Columbia and her colleagues handed out surveys to 175 parents with a hypothetical scenario: their one-month-old infant was spitting up and crying a lot.

The researchers asked parents what they would do if the doctor diagnosed their child with GERD versus if the condition wasn't labeled, as well as what they would do if the doctor told them the medication to treat the condition was ineffective - as research suggests it is - or didn't say anything about its efficacy.

Survey participants were more likely to want medication if their hypothetical infant was given a GERD diagnosis. Even when parents were told the medicine probably wouldn't work, they rated their interest in treatment at about 2.5 out of 5.

However, with no disease label and with information about the medicine's lack of efficacy, parents rated their desire to treat below 1.5 out of 5, the researchers reported in Pediatrics.

"It shows how these kinds of labels can influence how people respond to symptoms," Scherer told Reuters Health. "Words can make an otherwise normal process seem like something that requires medical intervention."

She said current guidelines say the case of an irritable infant who cries and spits up frequently should probably not be treated as GERD - but that if doctors rule everything else out, they can try a two-week course of acid-reducing medication.

That caveat could further confuse doctors and parents into thinking medicine is likely to help, Scherer said.

"It's really becoming pretty clear that GERD in infants is overdiagnosed and overtreated. One reason for this could be that doctors' use of this GERD label could unintentionally increase people's (desire) for medications," she said.

Carey compared what's happening with GERD symptoms to the rising number of very active kids being diagnosed with and treated for attention deficit hyperactivity disorder (ADHD).

"Parents need to know that there are some annoying or insignificant variations of normal which one really needs to just put up with and not treat as a disease," he said.

"Be darn sure that there is an abnormality before treating it as such."

SOURCE: http://bit.ly/jsoh2P Pediatrics, online April 1, 2013.

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