All babies spit up from time to time — especially after a feeding. However, babies who spit up frequently and have other symptoms, like irritability and poor weight gain, may need medication for GERD.
GERD occurs in infants for several reasons, but it’s usually because the lower esophageal sphincter, which closes the esophagus off from the stomach, may not be mature enough to close properly.
Just like GERD in adults, GERD in infants and children can be managed several ways. Your doctor may first recommend that you make changes in feeding, such as burping your infant more frequently during feeds and holding them upright for a half hour after each feeding.
If changes in feeding don’t seem to help your baby, your doctor may recommend medications.
There are several types of medications that may help relieve GERD symptoms in your little one.
Mucosal surface barriers
Mucosal surface barriers, or foaming agents, help protect the surface of the esophagus from stomach acid.
One example is Gaviscon Infant, a form of the medication formulated for children. The main side effects of this medication are constipation and diarrhea.
Gastric antisecretory agents
Gastric antisecretory agents are the most commonly prescribed mediation for infants. They help reduce the amount of acid the stomach produces.
There are two kinds of antisecretory agents that help reduce the acid in the stomach. These are histamine H2 receptor antagonists (H2RAs, or H2 blockers) and proton pump inhibitors (PPIs).
H2RAs
Famotidine (Pepcid) is generally considered safe for little ones. You can give a liquid form of the medication to infants and use chewable tablets for children.
This medication starts working quickly, so it’s useful to have in a pinch. However, they aren’t usually recommended for long-term use in infants.
PPIs
PPIs are another class of drugs that reduce the amount of acid in the stomach. While PPIs aren’t officially approved for general use in infants under one year old, esomeprazole has recently been approved for use in infants over one month old for certain conditions.
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.
Your child’s doctor may consider prescribing these medications if they believe the benefits outweigh the risks.
There are some concerns about reflux medications being overprescribed. It’s important to keep in mind that most babies will spit up from time to time, and they don’t always require medication.
Two-thirds of infants experience gastroesophageal reflux. The American Academy of Pediatrics recommends against the use of acid suppressants unless infants have other symptoms of GERD.
Acid suppressant medications have been linked to a higher number of serious infections, and babies who take them are more likely to develop an infection that includes diarrhea.
There may also be long term effects from taking acid suppressants. Infants who take these medications are more likely to develop asthma and have a bone fracture later in their life compared to children who do not take them.
Because of the potential health risks, it’s generally recommended that the lowest effective dosage of reflux medications be used for the shortest amount of time necessary.
When using GERD mediations, it’s important to consider the costs and benefits.
As mentioned before, both H2RAs and PPIs reduce the amount of acid in the stomach. While this may be beneficial for babies with GERD, stomach acid also helps to protect from infection. That’s why infants who take these medications are at increased risk for pneumonia and gastrointestinal tract (GI) infections.
Additionally, prolonged use of PPIs can make it difficult for the body to absorb calcium. This may explain the increased risk of bone fractures later in life.
It’s important to work closely with your pediatrician to understand how medications prescribed for your infant may impact their body now and in the future.
Before trying medication, it may be a good idea to try home remedies. Additional ways to
- burping your little one more often during feeds
- feeding just a few ounces of breastmilk or formula at a time
- keeping baby upright for 20-30 minutes after feeds
- trying a different formula, but discuss this with a pediatrician first
If your baby is spitting up frequently and experiencing symptoms like poor weight gain, prolonged coughing, and discomfort, there are a variety of medications that can help control their stomach acid and protect their esophagus.
However, it’s important to also consider the potential side effects and other risks associated with these drugs.
Before starting medications, it’s a speak with your pediatrician about other changes you can make to your little one’s feeding routine. More frequent burping and keeping your baby upright after feeds may help decrease your baby’s discomfort and minimize the need for medications.