Use of Proton Pump Inhibitors in Infants

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M Lassalle, et al. The Journal of Pediatrics: Clinical Practice 2026; 21: 200214. Open Access! Use of Proton Pump Inhibitors in Infants: Nationwide Cohort Study Based on the French EPI-MERES Register

Methods: This studied children born between 2010 and 2021 using the French National Health Data System registry (EPI-MERES). PPI use was identified through prescriptions before age 1 year.

Key findings:

  • There were 703,891 PPI users among the 8,222,100 children included.
  • The incidence of PPI use was 54.4 per 100 person-years among children with hospital-diagnosed gastroesophageal reflux disease (GERD) (+ 33.6% between 2010 and 2021), and 7.9 per 100 person-years in those without (+ 63.6%).
  • PPI use was associated with extreme prematurity (aOR=1.91), digestive diseases (aOR=5.60), respiratory diseases, aOR, 2.73, neurological diseases (aOR=1.59), and with high maternal socioeconomic level (first quintile of deprivation index [least deprived] vs fifth quintile [most deprived] (aOR=1.80)
  • The median age at initiation of PPI treatment decreased over time, supporting the idea that PPI use may have become more commonplace.

Discussion:

  • The presence of underlying diseases may increase the use of PPIs as it is “consistent with the hypothesis that more frequent interactions with the healthcare system may be closely associated” increased prescriptions of PPIs.
  • Potential adverse PPI effects: “Early life PPI exposure has been associated with an increased risk of respiratory and gastrointestinal infections. [Also, there are] associations with immune-mediated diseases potentially mediated by microbiome alterations, including asthma,25,26 allergic disorders,26,27 and inflammatory bowel disease.28“
  • “PPI use in children aged <1 year may be appropriate, especially for esophagitis,1 but is not needed if the symptoms do not interfere with growth and development,1 and there is no evidence supporting empirical PPI therapy for diagnosing GERD in infants.1“

My take: This study shows that PPI use before age 1 has increased sharply in France since 2010. This coincides with high usage in infants elsewhere despite lack of proven efficacy. However, a recent study from Boston showed a declining trajectory of PPI use (see related posts). This indicates that a consistent message that most infants should not be treated with PPIs may be effective.

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