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WITHDRAWAL OF RANITIDINE

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 N-nitrosodimethylamine (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, discuss disposal with a pharmacist, or by following the FDA’s guidance.

If you have a baby, you know that spitting up is very common and usually nothing to fret over. But sometimes it can be an indication of acid reflux, especially when accompanied by other symptoms.

Acid reflux, also known as gastroesophageal reflux (GER), is the backing up of stomach contents into the esophagus and throat. It isn’t just an adult illness. Your little one can experience it, too. An infant with GER tends to spit up frequently or vomit.

If your baby is spitting up and exhibiting any of the following symptoms, it could be a sign of a more serious condition known as GERD (gastroesophageal reflux disease).

Watch for:

  • gurgling or wheezing sound while drinking or following a feeding
  • drooling more than usual
  • inconsolably crying that sounds like it may be from pain
  • irritability
  • pain signs such as arching of the back, wiggling excessively, or poor sleep
  • feeding difficulties
  • inadequate weight gain
  • refusal to eat
  • spit up that is green, red, or looks like coffee grounds

GERD is a complication of GER. In infants, GER is much more common than GERD.

The options for treating acid reflux in your baby depend on their age and the severity of the problem. Lifestyle changes and home care can sometimes work well. But always keep your baby’s doctor in the know.

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Give more frequent feedings

Your baby may be more likely to have reflux and to spit up when their stomach is too full. Increasing the frequency of feedings while decreasing the amount at each feed will likely help.

Breastfed babies may benefit from a change in the breastfeeding parent’s diet. Some studies have shown that babies can benefit when the breastfeeding parent restricts their intake of milk and eggs, though more research is needed. Formula-fed infants may be helped by a change in formula.

Avoid making any dietary or formula changes without discussing with your child’s doctor first.

A less-full stomach puts less pressure on the lower esophageal sphincter (LES). The LES is the ring of muscle that prevents food from going back into the esophagus from the stomach.

Pressure on this muscle causes it to lose effectiveness, allowing stomach contents to rise into the throat. LES strength takes time to develop over the first year, so many infants naturally spit up often.

Feeding on demand, or whenever your baby appears to be hungry, may also be helpful.

Feed them upright

If you can, feed baby upright and keep them in that position for about 30 minutes after. This can aid in preventing acids from creeping up.

Avoid sleep positioners

Don’t be tempted to try a sleep positioner while feeding or sleeping. These are padded risers that can keep your baby’s head and body in one position.

The Consumer Product Safety Commission and the Federal Drug Administration (FDA) have not recommended these due to the risk of sudden infant death syndrome (SIDS) or suffocation.

Check bottle and nipple size

If you bottle feed, keep the nipple filled with milk throughout feedings to avoid air gulping. Try a variety of nipples, avoiding those with larger holes that can cause milk to flow too fast.

Buy slow flow bottle nipples online.

Thicken breast milk or formula

With your pediatrician’s approval, adding a small amount of infant rice cereal to formula or breast milk may be an option to lessen spitting up.

Thickening the food is thought to help stop stomach contents from sloshing up into the esophagus. This option has not been shown to decrease other reflux symptoms. Check with your doctor before trying this option.

Burp them more often

Whether you bottle-feed or breastfeed, make sure to frequently burp your baby. Burping your infant during a feeding may help with reflux symptoms.

Burp bottle-fed infants after every 1 to 2 ounces (or more frequently if they eat less). Burp breastfed babies any time they pull off the nipple.

Always put baby to sleep on their back on a firm mattress. Make sure the crib or sleeping area is free of thick blankets, pillows, loose objects, or plush toys.

Studies have shown an increased risk of SIDS in all sleeping positions except for on the back. This applies to all babies, even those with GER and GERD.

Babies who sleep at an incline in a car seat or carrier have been shown to have more reflux as well as an increased risk of SIDS.

Consider scheduling a bit of time between sleeping and eating instead of changing positions.

Although you might be tempted to try gripe water to ease symptoms of reflux, there’s no scientific evidence of its effectiveness.

Ingredients vary depending on the manufacturer, but many versions of gripe water include fennel, ginger, peppermint, lemon balm, chamomile, and sodium bicarbonate.

The World Health Organization says that giving anything other than breast milk to infants younger than 6 months may increase the risk of bacterial infection, serious allergies, and stomach irritation.

If given regularly, gripe water can also create significant problems with an infant’s blood chemistry.

Speak to your baby’s pediatrician if you’re interested in using natural remedies to treat your child’s reflux. You will want to make sure you are choosing both safe and proven remedies.

Tip

Avoid products that contain vegetable carbon (sometimes labeled as carbo vegetabilis or activated charcoal), alcohol, and sucrose due to adverse effects.

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If lifestyle changes don’t help, your pediatrician may recommend further investigation into other causes of your baby’s symptoms, such as GERD.

Although medications like omeprazole (Prilosec) have been frequently used for treatment, studies question their effectiveness. The main function of these medications is to reduce stomach acid.

Multiple studies have failed to show that these medications improve symptoms any better than no medication at all in many infants.

Additionally, medication use may be associated with adverse side effects such as gastrointestinal infections, bacterial overgrowth, bone health problems, and drug interactions.

One particular concern with these medications is risk of infection. Stomach acid naturally protects the body from dangerous organisms that can be found in water and food.

Reducing stomach acid may increase an infant’s risk of these kinds of infections. Talk to your doctor about which treatment plan is best for your baby based on the severity of their symptoms. Medication may still be the best option for infants with severe symptoms.

Surgery may be an option if medications and lifestyle adjustments don’t help ease your baby’s symptoms and if your baby isn’t gaining weight or has other complications. Tightening the LES makes it more stable so that less acid flows back into the esophagus.

The need for this type of surgery is rare, especially in infants. The procedure, called fundoplication, is usually reserved for babies whose reflux causes severe breathing problems or prevents growth.

Acid reflux in an infant is a treatable condition. Finding the lifestyle changes that work for your wee one will likely help get their acid reflux under control.

In many cases, adjustments at home may be all that’s needed to make your infant more comfortable. Mild cases can also go away with time.

Symptoms may also overlap with other conditions such as pyloric stenosis. This is a serious condition that causes abnormal tightening of a muscle that prevents proper emptying of the stomach. Pyloric stenosis causes forceful vomiting and should be evaluated by a doctor.

No matter what your baby’s symptoms, talk to your doctor about your concerns, so they can accurately diagnose the problem and help you find the best method for reducing your baby’s discomfort.

Q:

What if lifestyle changes don’t help my infant’s acid reflux?

Concerned parent

A:

If changes like frequent burping, smaller meals, and formula changes do not help your infant’s symptoms, it’s important to talk to your doctor. Your baby may have other medical problems not related to GER, or they may have developed GERD.

It is important to receive the proper diagnosis in order to get the best treatment for your baby. When lifestyle treatments are not helpful, other testing will be necessary.

Judith Marcin, MDAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.
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