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How 'disease' label in kids affects treatment

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Once a child's behavior is labeled as a "disease," parents are more willing to use medications to treat their child, even if they are told the medications aren't effective, a new study suggests.

In the study, 175 parents of healthy 1-month-old infants at a clinic in Michigan were asked to imagine that their baby was spitting up and crying frequently. Parents then imagined that took their infant to a doctor, and some were told that the doctor said the child had gastroesophageal reflux disease (GERD), while others were told the doctor did not diagnose a specific disease.

Parents who were told their child had GERD were interested in treating their infant with medications, even when they were told the medications probably wouldn't help improve the child's symptoms. In contrast, parents who weren't given a disease label by a doctor were not interested in using the medications if they were told the medications were not effective.

While many young children cry and spit up excessively, few actually have GERD, a condition that can only be confirmed when doctors use an instrument called an endoscope to look down a child's throat. However, many doctors unnecessarily diagnose GERD when a child exhibits these normal behaviors, and prescribe unnecessary treatments, the researchers said. Between 1999 and 2004, there was a sevenfold increase in the use of medications to treat GERD, the researchers said.

"Doctors may inadvertently encourage the use of questionable medical interventions and foster medicalization of minor pediatric illnesses by using labels that increase patients’ perceived need for treatment," the researchers write in the April 1 issue of the journal Pediatrics.

In a commentary accompanying the study, Dr. William Carey, of the Children’s Hospital of Philadelphia, said: "This is compelling evidence that the choice of words by physicians can significantly affect parents' views of their children’s health."

"This paper should reinforce the need to focus attention on pediatric pathogenesis, and strengthen efforts to reduce it," Carey said. The way doctors identify and deal with perhaps annoying yet normal children's behavior, and how doctors discuss children's health with parents "makes a big difference in the quality of care,"  he added.

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