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WITHDRAWAL OF RANITIDINE
In April 2020, the
Food and Drug Administration (FDA)Trusted Sourcerequested 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.
Acid reflux, also known as gastroesophageal reflux (GER) is the backing up of stomach contents into the throat. It isn’t just an adult illness. Infants can experience it, too. An infant with GER will spit up frequently or vomit. If your infant has those symptoms plus irritability, feeding difficulties, inadequate weight gain, coughing, choking, or wheezing after feeding, it may be a sign of a more serious condition known as GERD (gastroesophageal reflux disease). GERD is a complication of GER. In infants, GER is much more common than GERD.
The options for treating acid reflux in your infant depend on your baby’s age and the severity of the problem. Lifestyle changes and simple home care are typically the best place to start.
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 mother’s diet. Some studies have shown that babies benefit when mom restricts her intake of milk and eggs. Formula-fed infants may be helped by a change in formula.
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.
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.
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.
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 one to two ounces. Burp breastfed babies any time they pull off the nipple.
Always put your 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 sudden infant death syndrome (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.
Although parents sometimes 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.
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.
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 child 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. Talk to your doctor about your concerns, so they can help you find the best method for reducing your baby’s reflux.
Q: What if lifestyle changes don’t help my infant’s acid reflux?
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, MD
Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.