In April 2020, the Food and Drug Administration (FDA) requested that all forms of prescription and over-the-counter (OTC) ranitidine (Zantac) be removed from the U.S. market. This recommendation was made because unacceptable levels of NDMA, a probable carcinogen (cancer-causing chemical), were found in some ranitidine products. If you’re prescribed ranitidine, talk with your doctor about safe alternative options before stopping the drug. If you’re taking OTC ranitidine, stop taking the drug and talk with your healthcare provider about alternative options. Instead of taking unused ranitidine products to a drug take-back site, dispose of them according to the product’s instructions or by following the FDA’s guidance.

Ranitidine, brand name Zantac, is now marketed as Zantac 360, which contains a different active ingredient (famotidine). Famotidine is in the same class as ranitidine and works the same way but has not been found to contain unacceptable levels of NDMA.

What is GERD?

Gastroesophageal reflux disease (GERD) is a digestive disorder that’s referred to as pediatric GERD when it affects young people. Nearly 10 percent of teens and preteens in the United States are affected by GERD according to GIKids.

GERD can be difficult to diagnose in children. How can parents tell the difference between a little indigestion or the flu and GERD? What does treatment involve for young people with GERD?

What is pediatric GERD?

GERD occurs when stomach acid backs up into the esophagus during or after a meal and causes pain or other symptoms. The esophagus is the tube that connects the mouth to the stomach. The valve at the bottom of the esophagus opens to let food down and closes to stop acid from coming up. When this valve opens or closes at the wrong time, this may cause symptoms of GERD. When a baby spits up or vomits, they’re likely displaying gastroesophageal reflux (GER), which is considered common in infants and usually doesn’t cause other symptoms.

In infants, GERD is a less common, more serious form of spitting up. Children and adolescents may be diagnosed with GERD if they show symptoms and experience other complications. The potential complications of GERD include respiratory problems, difficulty gaining weight, and inflammation of the esophagus, or esophagitis, according to Johns Hopkins Children’s Center.

Symptoms of pediatric GERD

The symptoms of childhood GERD are more serious than the occasional stomachache or infrequent act of spitting up. According to the Mayo Clinic, GERD may be present in infants and preschool children if they’re:

  • refusing to eat or not gaining any weight
  • experiencing breathing difficulties
  • starting with vomiting at 6 months of age or older
  • fussy or having pain after eating

GERD may be present in older children and adolescents if they:

  • have pain or burning in the upper chest, which is called heartburn
  • have pain or discomfort when swallowing
  • frequently cough, wheeze, or have hoarseness
  • have excessive belching
  • have frequent nausea
  • taste stomach acid in the throat
  • feel like food gets stuck in their throat
  • have pain that’s worse when lying down

Long-term bathing of the esophageal lining with stomach acid can lead to the precancerous condition Barrett’s esophagus. It can even lead to cancer of the esophagus if the disease isn’t effectively controlled, though this is rare in children.

What causes pediatric GERD?

Researchers aren’t always exactly sure what causes GERD in young people. According to Cedars-Sinai, several factors may be involved, including:

  • how long the esophagus is inside of the abdomen
  • the angle of His, which is the angle where the stomach and esophagus meet
  • the condition of the muscles at the esophagus’s lower end
  • pinching of the fibers of the diaphragm

Some children may also have weak valves that are particularly sensitive to certain foods and beverages or inflammation in the esophagus that’s causing the problem.

How is pediatric GERD treated?

Treatment for pediatric GERD depends on the severity of the condition. Doctors will almost always advise parents, children, and teens to start with simple lifestyle changes. For example:

  • Eat smaller meals more often, and avoid eating two to three hours before bedtime.
  • Lose weight if necessary.
  • Avoid spicy foods, high-fat foods, and acidic fruits and vegetables, which can irritate your stomach.
  • Avoid carbonated beverages, alcohol, and tobacco smoke.
  • Elevate the head during sleep.
  • Avoid eating large meals before vigorous activities, sports games, or during times of stress.
  • Avoid wearing tight-fitting clothes.

Your child’s doctor may recommend medications that help reduce the amount of acid their stomach produces. These medications include:

  • antacids
  • histamine-2 blockers that reduce acid in the stomach, such as Pepcid
  • proton pump inhibitors that block acid, such as Nexium, Prilosec, and Prevacid

There’s some debate regarding starting young children on these medications. It’s not yet known what the long-term effects of these medications may be. You may want to focus on helping your child make lifestyle modifications. You may also want your child to try herbal remedies. Some parents feel that herbal remedies may be helpful, but the effectiveness of remedies is unproven and the long-term consequences for children taking them are unknown.

Doctors rarely consider surgery as a treatment for pediatric GERD. They generally reserve it for treating cases in which they can’t control serious complications, such as esophageal bleeding or ulcers.