acid reflux heartburn GERD logo

Infant Reflux Medications

A number of medicines have been used for children and to treat infant reflux...


Although these seem gentle, those available in liquid form today usually rely on magnesium or aluminum. These silvery metals could cause diarrhea or constipation in babies, and their long-term effects are not well understood. If it is absolutely necessary to use one of these, choose magnesium over aluminum.

H2-Receptor Antagonists

H2RA’s (H2-Receptor Antagonists) decrease acid production in the stomach. They do not decrease the reflux itself, but make the refluxed liquid less acidic so it is less likely to cause irritation. The H2RA’s commonly used in children include cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid) and ranitidine (Zantac). Tagamet is not approved by the FDA for children under 16 and Axid is not approved by the FDA for children under 12. Pepcid and Zantac are now approved for children, even infants. Zantac is a strong drug and has brought relief to many babies. It is well tolerated by most children. Headaches, sometimes severe, are the most commonly reported side effects in those old enough to describe them. The most serious side effects, heart rhythm abnormalities, can be caused by any medicine in this class – but they are quite rare. Because there has been a lot of experience with these medications, they are usually the first to be used for infant reflux.

Proton pump inhibiters

Proton pump inhibiters are more powerful at blocking acid production. Those commonly used in children include esomeprazole (Nexium ), lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix), and rabeprazole (Aciphex).

Protonix, and Aciphex are not approved by the FDA for use in children. Nexium is not approved by the FDA for use under 12 years. Prevacid and Prilosec are newly approved by the FDA for use in children as young as 1 year old.

Prokinetic Agents

Prokinetic agents help speed along whatever is in the stomach, and to tighten the valve at the top of the stomach so acid is less likely to slosh up. Prokinetic medicines used in children include bethanechol (Urecholine), metoclopramide (Reglan), and the antibiotic erythromycin. Urecholine has not been approved by the FDA for use in children. Nor has Reglan been approved for use in children. in fact, caution is strongly recommended because of increased risk of neurological side effects in children. Erythromycin has been approved by the FDA for children, but not for treating reflux in them. Propulsid falls into this category, but thankfully is no longer used. It was extremely popular for several years, but when looked at carefully was found to have killed 80 people taking it!!!

Many of these drugs have not been approved by the FDA for use in children. "Safety and effectiveness in children have not been established." Do they really work? Are they really safe? We really don't know. Most of what we do know about both drugs has been learned from their use in adults. This does not mean that your physician was wrong to prescribe them. Pediatricians routinely use many drugs which are not FDA approved for a particular use or patient population. Often, this is because the drugs have never been systematically studied in children, not because they are known to be especially dangerous to children.

The human body is amazing. Even as we consider the options for treating reflux, your baby is already busy doing the real work. Silently, the muscles mature and coordinate. The great majority of babies with infant reflux cure themselves, with nothing but a tincture of time and some thoughtful, gentle relief.

Infant Reflux Medications References

By Mortin - Copyright 2009
Last modification 31/12/2009