Eight-Year Trends in Nationwide Proton Pump Inhibitor Use Among Finnish Children Under 6 Years by Sector and Specialty

Proton pump inhibitors (PPIs) are a common treatment for gastro-esophageal reflux disease. In young children, many reflux symptoms are physiological and PPI-therapy is not always necessary. Long-term PPI use has been associated with higher risks of infections, fractures, autoimmune diseases, and allergies. Therefore, PPIs should be prescribed cautiously in young children. This study evaluated 8-year trends in PPI prescribing and purchasing among young Finnish children < 6 years, focusing on the provider sector and physician specialty. This nationwide register-based study used Finnish Prescription Centre data on all outpatient PPI prescriptions and purchases for children < 6 years (2017–2024). Annual prescription and purchase rates per 1000 children were analyzed by age group (< 1, 1–2, 3–5 years), healthcare sector (private/public), sex, and physician specialty. Among 612,428 children < 6 years, 2.9% received ≥ 1 PPI prescription and 2.5% made ≥ 1 purchase, totaling 35,500 prescriptions and 50,781 purchases. PPI use was greatest in infants < 1 year but declined after 2018. Rates in older children remained stable. Pediatricians prescribed most PPIs (63.5%), mainly in the private sector; followed by general practitioners (27.9%), mainly in the public sector. Private providers prescribed more PPIs than public providers (68.1 versus 31.9%, p < 0.001). Pediatricians prescribed 79.0% of PPIs in infants < 1 year. Esomeprazole dominated purchases (60.4%), which were more common in boys. PPI use in Finnish infants declined after 2018 and remained stable in older children. Most prescriptions originated from private-sector pediatricians. Esomeprazole was the most commonly purchased PPI, and purchases were more frequent among boys.