Page 66 - Retail Pharmacy Assistants - November 2020

64 LITTLE LEGENDS CBy Nerine Zoio. hildren from infants up to adolescents aren’t spared the woes of gastro- oesophageal reflux disease (GORD). Those affected must endure symptoms and complications arising from it such as a refusal to eat, gagging or choking, sleep disturbances, abdominal pain, poor weight gain and respiratory issues. Pharmacists and their assistants can reassure parents that reflux, associated with vomiting or regurgitation, is common in infants but usually improves by the age of one year, Advanced Practice Pharmacist Debbie Rigby tells Retail Pharmacy Assistants. However, for some children it will morph into GORD from age two or three onwards, with gastrointestinal disorders such as heartburn, regurgitation and vomiting often requiring medication, including the use of proton pump inhibitors (PPIs). When pharmacists and their assistants face a child that might have GORD, they have to dig in a bit to find out what’s going on, Ms Rigby says. “Here, history is so important,” she said. “Often children can be allergic to cow’s milk when it’s first introduced, as an example, or even have difficulty with a change of formula.” If the problem is an allergy or intolerance, the baby can be fed a hypoallergenic formula for a fortnight if they’re still on formula, whereas breastfeeding mothers can experiment with avoiding certain food, such as dairy products, Ms Rigby says. “So, taking a good history is crucial, including whether they’ve changed anything in their diet recently or introduced new foods, as well as checking what medicines they’re taking and whether they’re causing the symptoms,” she said. “That’s why it’s so important that young children are referred to a GP for a proper assessment and diagnosis, with children requiring a PPI needing the continuing guidance of a GP.” Ms Rigby says that in her experience, GPs are loath to prescribe PPIs for children, doing so only when other interventions have failed. Common interventions to alleviate symptoms A popular intervention, among many others, includes smaller feeds or meals with, at times, fluids that are thickened with rice cereals and other commercial thickening agents, Ms Rigby says. Raising the head of the cot or bed, as with adults, and making sure that children are upright when consuming food and that they don’t over-consume also “make a difference”. If a baby vomits, it’s best to keep them waiting until the next feed, rather than feeding them again, Ms Rigby adds. Babies should ideally be kept upright for at least half an hour after a feed, in loose clothing around their midriff, and not played with or bounced around during that time. Other helpful tips include giving a baby a device that helps them swallow, such as a dummy, burping them often, and not lifting their legs but instead rolling them to the side when changing nappies. Older children should be motivated to experiment with different sleeping positions. Even (sugar-free) chewing gum can help, as it may eliminate acid from the oesophagus, Ms Rigby says. Keeping an eye on PPI use Ms Rigby highlights that pharmacists will use their discretion in the absence of a GP and recommend PPI use in a child, with the caveat that if symptoms don’t disappear within a fortnight a GP must be consulted. “It’s so important that pharmacies use their position on the frontline to make sure that patients who use PPIs – whether child or adult – aren’t using them unnecessarily and for too long, with many unwanted side effects,” she said. “It’s a burdensome situation, not only in terms of cost but also the potential for harm.” She says it’s also important that when it comes to OTC PPIs, the patient is put on the lowest effective dose. Ms Rigby points to a recent study finding that PPIs taken for acid reflux may lead to an increased risk for fractures in children and adolescents, with the recommendation that follow up should take place where healthcare professionals need to reconsider administering this medication to children and adolescents. The study published online in March in the Journal of Pediatric Gastroenterology and Nutrition used data on children and adolescents, with an average age of four, from June 2011 to December 2015 (32,000 PPI care encounters) over 51 US children’s hospitals. The researchers observed a statistically significant higher rate of fractures among the PPI-exposed group (1.4 versus 1.2 per cent). The difference remained statistically significant after adjusting for remaining differences in sex, race, encounter type, payer and resource intensity after matching. The most RETAIL PHARMACY ASSISTANTS • NOV 2020 doesn’t spare children