Belgian Babies Get Reflux Meds at Triple European Rate

A new study reveals that approximately 7.1% of Belgian babies — one in thirteen — receive medication for gastroesophageal reflux during their first year of life, a rate far exceeding most European countries. The findings, published by the Onafhankelijke Ziekenfondsen (Independent Health Insurance Funds), have sparked concerns among health experts about potential overprescription of proton pump inhibitors (PPIs) in infants.

Context: What Is Infant Reflux?

Gastroesophageal reflux — the backflow of milk or stomach contents into the esophagus — affects approximately half of all babies younger than three months. In most cases, the condition resolves spontaneously by the age of one year without medical intervention. Medication is typically considered only when reflux causes severe or persistent symptoms.

PPIs, the class of drugs most commonly prescribed, work by reducing stomach acid production. While generally safe for short-term use, prolonged exposure in infants carries increased risks of gastrointestinal infections, allergic reactions, asthma, and disruption of the gut microbiome.

Key Findings

The study, based on data from 21,000 to 23,000 newborns between 2016 and 2024, found that Belgian babies receive reflux medication at a rate of 178 prescriptions per 1,000 newborns. This compares starkly with other European nations: Norway recorded just 1.1% of newborns receiving such medication, while Denmark reported 46.6 prescriptions per 1,000 newborns and Sweden 18.9 per 1,000. Only France, with 162 prescriptions per 1,000 children under two, showed comparable usage.

Usage has declined only marginally over the study period, from 7.6% in 2016 to 7.1% in 2024. Treatment durations are also notable: children receiving medication use it for an average of more than two months, with four in ten taking it for at least two months and nearly one in five for at least four months.

Stark Regional Disparities

Perhaps the most striking finding is the dramatic variation within Belgium itself. In Wallonia, 13% of babies receive reflux medication during their first year — more than three times the rate in Flanders and Brussels, where approximately 4% of infants are treated.

Gender and socioeconomic differences also emerged. Boys receive medication more often than girls (8.0% versus 6.2%), and babies from families without increased allowance receive prescriptions more frequently than those from lower-income households (7.3% versus 5.3%).

The Role of Pediatricians

Pediatricians write approximately three-quarters of all initial prescriptions, and the study reveals significant variation between individual practitioners. Half of pediatricians prescribe reflux medication to at most 1.5% of the infants they see, while a quarter prescribe to at least 3.2% of their young patients. This suggests differing clinical approaches to managing infant reflux rather than consistent medical guidelines.

Expert Concerns

“That one in thirteen babies receives reflux medication during the first year of life, often for several months, and that there are strong variations in use, shows that it is important to monitor this issue,” said Wies Kestens, an expert at the Onafhankelijke Ziekenfondsen, as reported by HLN. “Especially because unnecessary and long treatments increase the risk of side effects.”

The organization emphasized in its press release that “a careful evaluation of symptoms remains essential to avoid unnecessary medication in young children.”

Analysis: Why Is Belgian PPI Use So High?

The study does not definitively explain why Belgian prescribing rates are so elevated, but several factors may contribute. The significant variation between individual pediatricians suggests differing interpretations of clinical guidelines. The three-to-one ratio between Wallonia and Flanders may reflect distinct medical traditions, training approaches, or patient expectations.

Parental pressure may also play a role. Parents distressed by their baby’s persistent crying or spitting up may seek medical intervention, and without adequate emphasis on conservative management — such as feeding adjustments and positioning — medication may be prescribed as a first-line response rather than a last resort.

Recommendations and Forward Look

The Onafhankelijke Ziekenfondsen advocate for several measures: better information for parents about the typically self-limiting nature of infant reflux, more critical evaluation of whether medication is truly necessary, regular reassessment of treatment when medication is prescribed, and greater emphasis on non-pharmacological approaches as first-line treatment.

These findings raise broader questions about whether Belgium needs national guidelines for infant reflux management and whether health authorities will take action to address the prescribing disparities. As the research continues to circulate through Belgian medical publications including Medi-Sfeer, the pressure for policy responses is likely to grow.

For parents, the message from health experts is clear: infant reflux is common and usually resolves on its own. Before turning to medication, a careful evaluation and discussion with a healthcare provider about non-pharmacological options is essential.