Talk is Cheap, Often Effective: Symptoms in Infants Often Respond to Non-Pharmacologic Measures

In this issue of The Journal, Orenstein and McGowan document the results of their well-designed study of “conservative therapy” for infants presenting with symptoms suggesting infant gastroesophageal reflux.¹ “Suggesting” is the operative word, as the title indicates. The infants were to be enrolled in a randomized, double-blind study of oral H₂-receptor antagonist versus placebo, but before randomization, they underwent a trial of “conservative” management, meaning nonpharmacologic. This consisted of avoidance of tobacco smoke exposure and modifications of position and of feeding. Formula-fed infants were switched to a semi-elemental formula, and mothers of breast-fed infants avoided cow and soy milk in their diets. Feedings were thickened with rice cereal. The modifications were taught to parents in the primary care setting in 5 office practices. With a symptom scoring instrument used at baseline and at 2 weeks, symptom scores declined impressively—78% had some improvement in scores, 59% had improvement by at least 5 points, and 24% normalized. Scores for individual symptoms related to regurgitation, crying, and arching improved significantly. The 37 subjects had a median age of 13 weeks (range 4 to 43) at entry.

Abbreviations: GER, Gastroesophageal reflux, GERD, Gastroesophageal reflux disease, PPIs, Proton pump inhibitors