Tradition, conditioning influence parental perceptions of GERD in Asian infants

In the first 3 months of a newborn’s life, the prevalence of gastroesophageal reflux disease (GERD) is at its peak, but most infants outgrow it by age 1 year, according to a Singapore study, noting that those breastfed at 3 weeks have a lower likelihood of GERD.

In addition, parental perceptions in GERD are influenced by cultural-based changes, such as elimination of “heaty or cold” food, which are unique to Asians.

“Understanding the cultural basis for parental perceptions and health-seeking behaviours is crucial in tailoring patient education appropriately for optimal management of infant GERD,” said the researchers, led by Vanessa ZY McLoughlin, who prospectively followed mother-infant dyads in the Singapore PREconception Study of long-Term maternal and child Outcomes (S-PRESTO) cohort from preconception to 12 months after delivery.

GERD was diagnosed using the revised Infant Gastroesophageal Reflux Questionnaire (I-GERQ-R), which was administered at four time points during infancy. The researchers then collected data on parental perceptions and lifestyle modifications.

Infant GERD prevalence was highest at age 6 weeks, peaking at 26.5 percent before decreasing to 1.1 percent by month 12. However, those exclusively breastfed at 3 weeks of life were less likely to develop GERD by 1 year (adjusted odds ratio, 0.43, 95 percent confidence interval [CI], 0.19‒0.97; p=0.04). [Ann Acad Med Singap 2022;51:263-271]

In a meta-analysis of four earlier studies of infants from birth to 3 years, the findings showed a GERD prevalence estimated at 26.9 percent (95 percent CI, 20.1‒33.7). In other studies, regurgitation reported as the primary surrogate symptom for GERD had a prevalence of 20‒50 percent. [J Pediatr Gastroenterol Nutr 2019;68:811-817; BMC Pediatr 2020;20:152]

In response to GERD symptoms, parents reported eliminating “cold or heaty food” and “gas-producing” vegetables, massaging their baby’s abdomen, and applying medicated oil to the infant’s abdomen.

“Exclusively breastfed infants in this cohort had reduced odds of GERD, but the mode of breast milk feeding did not appear to impact GERD risk,” the researchers said.

“Some studies have, however, reported a protective effect of feeding at the breast against reflux,” they added. [Breastfeed Med 2011;6:205-208; Pediatr Gastroenterol Hepatol Nutr 2013;16:240-247; J Hum Lact 2017;33:267-277; Pediatrics 2009;123:779-783]

Asian practices

In Singapore, tradition and social conditioning influence infant feeding practices. Caregivers also tend to seek advice from friends and family rather than from health professionals. Maternal dietary changes are also common, including the elimination of spicy foods, “cold” foods and drinks, and “gas-producing” vegetables. [Nutrients 2016;8:293]

“The concept of ‘cold’ or ‘heaty’ foods, ‘wind,’ and ‘gas-producing’ vegetables are common in complementary and alternative medicine practices such as traditional Chinese medicine, whereby a delicate balance of the yin and yang energies is essential for good health,” the researchers explained. [J Pharmacopuncture 2016;19:293-302]

“While our findings are not surprising given that complementary and alternative medicine is a salient part of Asian culture, the study highlights the uniqueness and importance of understanding the cultural basis for parental perceptions, implementation of common nonpharmacological remedies, and health-seeking behaviours for infant GERD in other parts of the world,” they added.