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4 Preventing overdiagnosis in the first months of life
  1. Pamela Douglas
  1. Possums Education, Brisbane, Australia. The University of Queensland, Brisbane, Australia. Griffith University, Brisbane, Australia


The developmental origins of disease, and the significance of the first 1000 days in determining health life-long, are now widely accepted. In the critically neuroplastic first months post-birth, environmental factors alter epigenomic regulation and impact upon neural templates and gut microbiome, with potential long-term impact on the infant’s neurodevelopment and stress response, metabolic, immune, and gut health settings.

Yet the care of parents and their babies is in crisis in developed countries, due to rampant inappropriate medicalisation of common post-birth problems, and associated high health system costs. Parents complain of receiving conflicting and confusing advice, turning to multiple health providers. Unnecessary and potentially harmful post-birth treatments for problems of feeding and unsettled infant behaviour, which lack an evidence-base, are mainstreamed within the maternity suites of our hospitals, in Australian government-funded maternal and child health services, and in primary and secondary health care. There is a resultant widespread use of pharmaceutical, surgical, and chiropractic interventions which have been demonstrated either not to help, or to risk worsened outcomes for our babies and their families.

The current epidemic of inappropriate diagnosis of oral connective tissue restrictions comprises the third wave of inappropriate medicalisation of breastfeeding problems and unsettled infant behaviour since the late 1980s. The rate of Medicare-funded frenotomy increased by 420% in Australia in 0-4 year olds between 2006-2016, reflecting trends in Canada and the United States. Our team’s study did not include dentists, who aren’t funded by Medicare and who may be performing the majority. In the Australian Capital Territory, where there was no dentist available to offer laser frenotomy in this period, the Medicare-funded frenotomy rate increased by 3710%, which may more accurately reflect total rates. Laser frenotomies for diagnoses of posterior tongue-tie, upper lip-tie and buccal ties may cost more than $1000, are not demonstrated to improve outcomes, and risk oral aversion, haemorrhage, and lingual nerve damage. Recently, a young infant required resuscitation and admission to intensive care in New South Wales post-frenotomy.

The first wave of overmedicalisation in infant care has been inappropriate diagnosis of infant ‘reflux’ or gastro-oesophageal reflux disease, still widely treated with pharmaceuticals despite conclusive evidence of lack of benefit and of associated risks; the second wave of overmedicalisation has been inappropriate diagnosis of allergy for unsettled infant behaviour, treated since the mid-1990s with maternal elimination diets, now demonstrated to increase the risk of true allergy.

This presentation will examine

  1. The conditions which are overdiagnosed and overtreated in early life, and why;

  2. The costs for parents and the health system;

  3. The historical overmedicalisation of infant-care;

  4. How overdiagnosis and overtreatment are perpetuated within the Australian health system, despite the evidence;

  5. Health system steps required to cease unnecessary medicalisation of newborns and infants, so that families receive effective, evidence-based clinical care when faced with the common problems of breastfeeding or feeding difficulties and unsettled infant behaviour.

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