Prescribing proton-pump inhibitors to irritable infants: where is the evidence?

Infants with gastroesophageal reflux present with multiple symptoms, including irritability. When a physician is evaluating such an irritable infant, she/he would often prescribe a histamine 2 receptor antagonist blocker. When this fails, proton-pump inhibitors (PPIs) are often prescribed. Evidence demonstrates that there has been a fourfold increase in the use of PPIs, which may be prescribed in children as young as 2 weeks of age. This article addresses multiple issues: variable pharmacokinetics, risk of infection, absence of an adequate oral preparation, and lack of clear evidence to support the efficacy of PPIs in irritable infants. Extreme caution should be used in prescribing PPIs to this vulnerable age group, particularly those less than 6 months of age. Until more data are available, we suggest that PPIs should be used only in infants with well-documented gastroesophageal reflux disease or as part of a clinical trial.