GERD and Acid Reflux in Infants and Children
What Are the Treatments for Acid Reflux in Infants and Children?
There are a variety of lifestyle measures you can try for acid reflux in your child:
- Elevating the head of the baby's crib or bassinet
- Holding the baby upright for 30 minutes after a feeding
- Thickening bottle feedings with cereal (do not do this without a doctor's supervision)
- Changing feeding schedules
- Trying solid food (with your doctor's approval)
For older children:
- Elevating the head of the child's bed
- Keeping the child upright for at least two hours after eating
- Serving several small meals throughout the day, rather than three large meals
- Limiting foods and beverages that seem to worsen your child's reflux
- Encouraging your child to get regular exercise
If the reflux is severe or doesn't get better, your doctor may recommend drugs to treat it.
Drugs to Lessen Gas
Drugs to Neutralize or Decrease Stomach Acid
- Antacids such as Mylanta and Maalox
- Histamine-2 (H2) blockers such as Axid, Pepcid, Tagamet, or Zantac
- Proton-pump inhibitors such as Nexium, Prilosec, Prevacid, Aciphex, and Protonix
Researchers aren't sure whether decreasing stomach acid lessens reflux in infants.
For the most part, drugs that decrease intestinal gas or neutralize stomach acid (antacids) are very safe. At high doses, antacids can cause some side effects, such as diarrhea. Chronic use of very high doses of Maalox or Mylanta may be associated with an increased risk of rickets (thinning of the bones) or vitamin B12 deficiency.
Side effects from medications that inhibit the production of stomach acid are quite uncommon. A small number of children may develop some sleepiness when they take Zantac, Pepcid, Axid, or Tagamet.
Drugs to Improve Intestinal Coordination
Propulsid. This drug was voluntarily withdrawn from the U.S. market in 2000; however, it is still available with very limited access. The drug works by increasing the pressure of the lower esophageal sphincter and increasing emptying of the stomach and the rate that food moves through the intestines. This helps reduce esophageal exposure to stomach contents. The drug is very effective for treating childhood reflux. However, the drug is associated with abnormal heart rhythms.
Reglan. This is another medication that helps speed up the digestion process. However, it is also associated with many side effects, some of which can be serious.
Erythromycin. This is an antibiotic usually used to treat bacterial infections. One common side effect of erythromycin is that it causes strong stomach contractions. This side effect is advantageous when the drug is used to treat reflux.
Surgery for Reflux in Children
Surgery isn't often needed to treat reflux in children. When it is necessary, the Nissen fundoplication is the most often performed surgery. During this procedure, the top part of the stomach is wrapped around the esophagus forming a cuff that contracts and closes off the esophagus whenever the stomach contracts -- preventing reflux.
The procedure is usually effective, but it is not without risk. Discuss the potential risks and benefits of this operation with your child's doctor.