Reflux: When Is It More Than a Laundry Problem?

Despite growing cautionary evidence against routine pharmacologic management of infant reflux, proton-pump inhibitors and H2-receptor antagonists are regularly asked for and prescribed at pediatric well-visits in the first year of life. It is important to distinguish between physiologic gastroesophageal reflux and gastroesopheal reflux disease, even though the symptoms can seem interchangeable and overlap with other normal developmental phenomena and common conditions, such as cow's milk protein intolerance. Careful history, ample anticipatory guidance, and nonpharmacologic intervention should be attempted before consideration of acid suppression therapy in the first year of life. If the general clinician feels medication is warranted in the absence of clear indicating medical comorbidities, consultation with a pediatric gastroenterologist should be considered.