Are we over-medicating babies?
You may have read the article in the New York Times this week that questioned what happens when there is a “medicalization of normal variations in physiology.” Huh? It was speaking to the idea that sometimes normal body functions are misinterpreted as abnormal. Perhaps the best example is reflux, which happens to every baby, is now too quickly labeled a disease (Gastroesophageal Reflux Disease, GERD). We then spend millions of dollars in a futile attempt to fix something that is really normal. The article suggests that the labeling of this normal function with the word “disease” pushes parents to seek treatment for something that is not otherwise a serious medical issue, thereby putting babies at risk for side effects and other unanticipated complications of treatment.
Now, as the article mentions, there are babies who have abnormal amounts of reflux. These babies are uncomfortable, have difficulty eating, and may even have difficulty gaining weight. Doctors realize this, and the article doesn’t suggest that the diagnosis is a fabrication—only that the frequency with which we label a baby as having GERD is out of proportion with their symptoms.
And this is true. Babies spit up. A lot. Parents worry. A lot. So it’s my job to determine if the spitting is normal or truly falls into the category of “disease.” It’s also true that a mouthful of spit up looks like everything your child ate came right back up. It didn’t. As an experiment, spill a full ounce of milk on a baby blanket; you will see that the puddle is significantly larger than what you see with a normal amount of spit up. Most people don’t know that starting an anti-reflux medication will not actually decrease the amount of reflux in most cases. The medication makes the baby less uncomfortable by changing the acid content of the stomach, but the common anti-reflux medications do nothing to tighten the opening between the esophagus and stomach. Time does that.
The point is twofold. First, doctors need to carefully choose the words they use to label a diagnosis. Telling a parent their child has a “disease” implies they need treatment to fix the problem. No wonder they expect me to give them medication. Second, parents need to be comfortable that some unpleasant parts of being a baby are just normal. In this case, the need to do load after load of laundry!