GERD Label in Infants Encourages Parents to Medicate

Diedtra Henderson

April 01, 2013

Parents who were told that fussy infants had gastrointestinal reflux disorder (GERD) were more interested in giving them medications — even when told the drugs would likely be ineffective — than when the children were not diagnosed with a disease, according to a new study.

Laura D. Scherer, PhD, of the Veterans Affairs Ann Arbor Center for Clinical Management Research, in Michigan, and the Department of Psychological Sciences at the University of Missouri, in Columbia, and colleagues reported the findings online on April 1 in Pediatrics.

From 1999 to 2004, there was a 7-fold increase in the use of GERD medicines, such as proton pump inhibitors, by children younger than 1 year, the research team reports, leading them to theorize that overuse of the GERD disease "label" could promote overtreatment of otherwise healthy infants.

They enrolled 175 parents older than 18 years whose infants had appointments at the University of Michigan's primary care pediatrics clinic from May 2011 to February 2012. The parents were randomly assigned to complete surveys with varying vignettes that featured a 1-month-old infant who cried excessively and spit up. Half of parents were told a physician provided the GERD label, and the disorder was referenced by acronym throughout the narrative. For the other parents, the symptoms were referred to as "this problem." In addition, half were told that medication probably "doesn't do anything to help improve symptoms in infants with GERD," whereas the others were given no information regarding drug efficacy.

"[A]s predicted, parents who received the GERD label in the scenario were more interested in medication than parents who did not receive that label, F(1,165) = 6.95, P < .01...[P]arents who received a GERD diagnosis were interested in medicating the infant, even when they were told that the medications are likely ineffective; however, parents not given a diagnosis were interested in medication only when they were allowed to assume that the medications are effective,"...," Dr. Scherer and colleagues report.

"This is compelling evidence that the choice of words by physicians can significantly affect parents' views of their children's health," William B. Carey, MD, FAAP, of the Division of General Pediatrics at the Children's Hospital of Philadelphia in Pennsylvania, writes in an accompanying editorial.

"Although this study was a questionnaire study assessing parental views of a hypothetical situation, not actual clinical cases, and the investigators did not assess physician thinking on management other than their choice of the diagnostic designation, the evidence here argues strongly against the use of a pathologic diagnosis when a disease has not been established," Dr. Carey continues.

The study authors do not disagree.

"We found that a GERD disease label increases interest in using medication when the medications are known to be ineffective," the authors conclude. "Hence, doctors may inadvertently encourage the use of questionable medical interventions and foster medicalization of minor pediatric illnesses by using labels that increase patients' perceived need for treatment."

Support for this study was provided by the National Institutes of Health. One study author disclosed receiving funding from the National Institute for Child Health and Human Development, and another author disclosed receiving a grant from the American Cancer Society. The other authors and commentator have disclosed no relevant financial relationships.

Pediatrics. Published online April 1, 2013. Abstract