Pediatric Medicine

All babies spit up from time to time—especially after a feeding. However, babies who spit up more often and have other troubling symptoms, such as poor weight gain, irritability, or a prolonged cough, may have gastroesophageal reflux disease (GERD).

With GERD, the contents of the stomach (acid and food) are regurgitated back up the esophagus, sometimes causing an infant to vomit. This can lead to poor weight gain and erosion of the esophagus.

GERD occurs in infants for several reasons. The lower esophageal sphincter, which closes the esophagus off from the stomach, may not be mature enough to close properly. Hiatal hernias, which happen when a part of the stomach sticks upward in the chest, are also a common cause of GERD in infants.

Just like GERD in adults, GERD in infants can be managed several ways. Along with changes in position while feeding, your doctor may prescribe medication to help your infant with the symptoms of GERD.

Types of Medications

There are four main types of medications that help relieve the symptoms of GERD in children: antacids, mucosal surface barriers, prokinetic agents, and gastric antisecretory agents.

Antacids

Gastric acid-buffering agents (antacids) help neutralize acid from the stomach. Some examples include Rolaids and Alka-Seltzer. Though they help relieve symptoms, antacids aren’t recommended for long-term use because they can cause complications and have side effects like diarrhea and constipation.

Mucosal Surface Barriers

Mucosal surface barriers or foaming agents, such as Gaviscon, help protect the surface of the esophagus from the stomach’s acid.

Prokinetic Agents

These drugs work by pushing food through the digestive system quickly. This helps heal ulcers and prevent some of the symptoms of GERD. Metoclopramide (Maxolon) is one example of a prokinetic agent.

This medication has many negative side effects, including:

  • irritability
  • dystonic reactions (abnormal muscle movements)
  • drowsiness
  • wetting
  • apnea (trouble breathing)

Gastric Antisecretory Agents

Gastric antisecretory agents help reduce the amount of acid the stomach produces and are the GERD medications most commonly prescribed for infants. The two kinds of antisecretory agents that help reduce the acid in the stomach are histamine-2 receptor antagonists (H2RAs, or H-2 blockers) and proton pump inhibitors (PPIs).

H2RAs

Some common H2RAs are cimetidine (Tagamet), ranitidine (Zantac), famotidine (Pepcid), and nizatidine (Axid). These medications act rapidly to relieve discomfort. According to research, H2RAs are acceptable to use for infants occasionally. However, they’re not recommended for long-term use.

PPIs

PPIs are another class of drugs that reduce the amount of acid in the stomach. Some common PPIs are esomeprazole (Nexium), omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (AcipHex), and pantoprazole (Protonix).

PPIs are generally more effective than H2RAs and are better for healing the esophagus from gastric secretions. Experts recommend using the smallest possible daily dose for infants. PPIs aren’t recommended for infants under one year old.

Additional Facts About GERD Medications

  • One literature review found that evidence to prove omeprazole’s effectiveness in infants was insufficient.
  • Both H2RAs and PPIs reduce the amount of acid in the stomach. Therefore, infants who take these medications are at increased risk for pneumonia and GI infections.
  • Prolonged use of PPIs has been connected with an increased risk for bone fractures in adults.

Work closely with your doctor to understand the benefits and risks of the medication if your infant has GERD and has been prescribed medication.