Conservative Measures Not Proven to Relieve Reflux in Infants

NEW YORK (Reuters Health) Feb 25 – Changes in infant positioning, changes in feeding, and other conservative measures do not have proven efficacy against gastroesophageal reflux disease (GERD) in infants, a literature review suggests.
"We should reconsider using these therapies in light of their ineffectiveness, as they often carry hidden costs and burdens," such as the need for mothers to express breast milk, Dr. Aaron E. Carroll, of the University of Washington in Seattle, told Reuters Health.

He and two colleagues identified and assessed 35 English-language reports on clinical studies of nonpharmacologic, nonsurgical therapy for infant GERD. Ten of these studies met the reviewers' pre-established standards for adequate inclusion criteria, randomization, and allocation concealment.

Two studies evaluated the effect of positioning changes on GERD. Neither placing an infant upright in an infant seat, rather than flat, nor elevating the head of a baby's bed reduced reflux, Dr. Carroll and his colleagues report in the February issue of Archives of Pediatrics and Adolescent Medicine. In fact, evidence from the first study suggested that placing an infant upright may actually worsen reflux.

Three studies investigated the effect of thickening infant formula with rice flour or carob bean gum. Neither intervention significantly improved reflux as monitored with pH probes, the reviewers determined. But in one study, formula thickened with rice flour did significantly decrease the number of frank vomiting episodes. Also, results from a fourth study comparing the two thickening strategies showed that carob bean gum was significantly more successful in reducing reflux than rice flour.

A crossover study found that the total number minutes of reflux was significantly greater when infants received dextrose 10% water than when they received dextrose 5% water or glucose polymer solution. It is possible, the authors suggest, that the caloric density or osmolality of feedings affect reflux. They found no high-quality study that evaluated the effect of changing feeding volume or frequency.

Other studies reviewed showed no evidence that pacifier use or changes in formula composition were beneficial for infants with GERD. "This review does not prove that these therapies do not work; it illustrates that no conclusive evidence exists to prove that they do work," Dr. Carroll's group emphasizes in the paper.

"Nearly all cases will get better without any therapy at all," Dr. Carroll said. "If the problem is severe, other treatments besides the ones we studied should be considered."

Arch Pediatr Adolesc Med 2002;156:109-113.

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