Babies spit up. It's almost a given that when you have a baby of a certain age, that you're going to walk around with a spit-up stain on your shoulder (after having given up) and acquire the habit of having some sort of rag handy. My older daughter was a prodigious spitter-upper and we referred to her main product as "spup". The other three? Not so much, but it happened. But all babies spit up at least sometimes. So why are so many babies being prescribed reflux medications—that may actually harm them in the long run—that don't really work?

Parents. Parents are the answer, putting pressure on doctors, who should be telling parents that in most cases reflux medication is unwarranted, because, well, because babies spit up.

Spitting up is normal. It's caused when the stomach is overfull and the muscles at the juncture of the esophagus and the stomach can't or don't hld in the contents. Sometimes you get a little burp, a bit of relief for that overfull stomach, along with sone of what was in there. And sometimes you have stealth spit-up that the baby doesn't even seem to notice. Hey! What's this white stuff all over me? Cool! Can I play with it?

So that's normal reflux. I've read conflicting accounts of just how prevalent it is, somewhere between 40-80% of babies. That's a lot, you know? And quite a few of those are simply regular spitter-uppers, whose suck, I guess, is bigger than their stomach. I heard way back that breastfed babies don't spit up, but I can't say that's true. Less, maybe, but they also fed more frequently and likely a bit less each time that my big spitters did, who happened to be bottlefed.

When there's concern, and when there's an actual medical need for medication, is when there is GERD (gastroesophageal reflux disease), when babies spit up a lot and ALSO appear to be in great pain. Doctors were concerned about my younger son having this (a statistically-high frequency in kids with Down syndrome) and wanted to do a barium scan of his esophagus, but he clearly wasn't in pain nor was he spitting up all that much, so I declined.

But other parents have perhaps less confidence (it helped that he was my 4th baby), and—hello! the media!—there's an incredible awareness about medications of all sorts now, and parents begin to suspect that there's something wrong with their kid, that he's the only kid to be doing this thing or that thing, and they want doctors to take care of it. Fix it! I know the feeling. Parenthood can be isolating and there aren't as many resources to check yourself against other kids, other babies, other parents, even though ironically with the internets there are thousands of resources, but none of them are in-person or anecdotal.

An estimated TWO MILLION kids under 4 were prescribed a reflux medication last year. And prescriptions for kids under 2 increased 56% from 2002 to 2006.  The concern here is that reflux medications cause a higher incidence of hip fractures in older folks who take them, and it's being extrapolated that it's due to effects on bone density, which means kid's bone growth could be compromised. Of course, there's been no testing of these medications on infants so no one knows for sure. In kids who do have GERD and who do need the medication, there's an understandable tradeoff. But kids who don't really need to be taking these drugs could be harmed unnecessarily.

Photo: savvytot.com