Health Services Research Unit

Reducing medications in infants

  • REducing MEDications in Infants (REMEDI)

    Gastro-oesphageal reflux, irritability or unsettled behaviours are experienced by a number of healthy, thriving infants. As the infant gets older, these issues tend to resolve spontaneously without the need for medical intervention. However, caring for an infant with gastro-oesophageal reflux, irritability or unsettled behaviours can be very challenging for parents and require support. 

    In an effort to help resolves these issues, infants are sometimes prescribed acid suppression therapies (AST). AST medications include proton pump inhibitors (e.g. omeprazole) and/or H2 receptor antagonists (e.g. ranitidine). What we know from the latest research is that these medications have been shown to have no benefit for infants with gastro-oesophageal reflux, irritability or unsettled behaviours - in fact, AST medications can cause harm in infants.

    Between May 2018 to April 2020, HSRU led a project aimed at reducing unnecessary prescribing of ASTs in infants in partnership with Safer Care Victoria. As part of the REMEDI project, a suite of resources were developed for clinicians and parents to:

    • Improve knowledge of gastro-oesophageal reflux and unsettled behaviours in infants
    • Improve awareness and knowledge of the potential harms of ASTs in infants
    • Provide guidance on how to cease unnecessary ASTs; and 
    • Provide practical strategies on how to manage an unsettled infant
    • Provide information for GPs

    The suite of resources were co-developed with a consumer representative and clinicians from the three pilot sites who participated in the REMEDI project. Positive feedback was received from parents and clinicians about the resources. All of the resources developed are in line with the current RCH Clinical Practice Guidelines (CPG) for  Gastro-oesophageal reflux disease in infants and  Unsettled or crying babies. We are excited to share the range of parent and clinician resources.

    Parent handouts

    Clinicians and GPs

    • Information for GPs
    • Irritable infant Assessment Flowchart - taken from the Unsettled or crying babies CPG
    • Communication script - this resource provides guidance to clinicians on how to have a conversation with parents about managing their infant with gastro-oesophageal reflux, irritability or unsettled behaviours; or who may be asking about ASTs; or their infant is already on an AST inappropriately.
    • Infant Gastro-oesophageal Reflux and Irritability: how to diagnose and manage webinar - this 40 minute webinar also include three role play scenarios demonstrating how to have meaningful conversations with parents.