Therapeutic dilemma of PPI use in infants—no longer a dilemma

While proton pump inhibitors (PPIs) are widely recognized for their effectiveness in treating gastroesophageal reflux disease in older children and adults, their use in infants is controversial due to the paucity of well-controlled studies demonstrating clear benefits. Furthermore, concerns about potential adverse effects, such as increased risks of gastrointestinal and respiratory infections, nutrient malabsorption and alterations in gut microbiota, complicate the decision-making process for health care providers and care givers. The current guidelines emphasize nonpharmacologic management for infantile reflux and recommend PPIs for very specific indications. Despite this, PPIs continue to be widely prescribed to infants.