Watching a newborn baby experience the pain of gastroesophageal reflux (GER) is truly heart-wrenching—and yet it's an "almost universal phenomenon" among preterm infants, according to the American Academy of Pediatrics (AAP). But while the AAP says evidence does not support the use of pharmacological remedies, a new clinical report from the AAP on GER in infants says patience is rewarded.

When babies are born, especially preterm, their little digestive systems can struggle to manage their new diets of milk or formula. As a result, many infants pass gastric contents back into the esophagus, which can cause them discomfort and is associated with longer hospitalizations for NICU babies due to poor weight gain or, in rare cases, associations with sleep apnea or respiratory difficulties.

Naturally, parents and care providers want to do whatever they can to alleviate the pain babies experience from GER. But in the new report, the AAP cautions against the use of medications.

"A lack of evidence of efficacy together with emerging evidence of significant harm (particularly with gastric acid blockade) strongly suggest that these agents should be used sparingly, if at all, in preterm infants," says Eric C. Eichenwald, MD, the lead author of the report.

The AAP's analysis of non-pharmacological suggestions for managing GER found that they also "have not been shown to reduce clinically assessed signs of GER in the preterm infant." However, because these options are conservative, there's nothing wrong with at least trying to provide relief to babies with GER by keeping their heads elevated during feedings or doing smaller and more frequent feedings.

Previously, the FDA had approved the use of infant sleep positioners for relief with GER, but later retracted their approval after the use of these products was associated with SIDS. The AAP echoes that caution in their report, saying parents should avoid "commercial devices designed to maintain head elevation in the crib."

With medications and sleep positioners out and not much confidence in non-pharmacologial options, what's a parent of a baby with GER to do? As difficult as it can be, the AAP says to wait it out—because the good news is the majority of babies outgrow the symptoms.


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