Care Parents Should Question: Medicating 'The Happy Spitter' And More

News bulletin: The American Academy of Pediatrics is encouraging parents to question their children's medical care.

Well, at least on certain very specific procedures that the academy says are not "wise choices."

"Choosing Wisely" is a new campaign stretching across many medical specialties, aimed at getting doctors and patients alike to "think and talk about medical tests and procedures that may be unnecessary, and in some instances can cause harm." (I'd add, and in virtually all cases cost lots of money.)

The Academy of Pediatrics had already put out five "things physicians and patients should question," including the use of antibiotics for viral infections and the use of cold medicines for children under 4, and today they add five more. I'd like to think most doctors wouldn't do these things anyway, but am also thinking maybe the full list should be handed out to new parents before they leave hospitals. The list is here, and the latest five include:

Don’t perform screening panels for food allergies without previous consideration of medical history.
Ordering screening panels (IgE tests) that test for a variety of food allergens without previous consideration of the medical history is not recommended. Sensitization (a positive test) without clinical allergy is common. For example, about 8% of the population tests positive to peanuts but only approximately 1% are truly allergic and exhibit symptoms upon ingestion. When symptoms suggest a food allergy, tests should be selected based upon a careful medical history.

Avoid using acid blockers and motility agents such as metoclopramide (generic) for physiologic gastroesophageal reflux (GER) that is effortless, painless and not affecting growth. Do not use medication in the so-called “happy-spitter.”
There is scant evidence that gastroesophageal reflux (GER) is a causative agent in many conditions though reflux may be a common association. There is accumulating evidence that acid-blocking and motility agents such as metoclopramide (generic) are not effective in physiologic GER. Long-term sequelae of infant GER is rare, and there is little evidence that acid blockade reduces these sequelae. The routine performance of upper gastrointestinal (GI) tract radiographic imaging to diagnose GER or gastroesophageal disease (GERD) is not justified. Parents should be counseled that GER is normal in infants and not associated with anything but stained clothes. GER that is associated with poor growth or significant respiratory symptoms should be further evaluated.

Flashback: I recall appealing to our pediatrician about the fountains of spit-up that would spew from my firstborn. She said, "Spit-up is not usually a health problem. It's a laundry problem." Nice to see she now has official confirmation.

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Carey Goldberg Editor, CommonHealth
Carey Goldberg is the editor of WBUR's CommonHealth section.



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