AS A PEDIATRIC PHARMACIST, you will hear more about treating GERD in children, now that both omeprazole (Losec, Omez) and esomeprazole (Nexium sachets) are approved for kids as young as one year. Spitting up and fussiness are common in babies up to 18 months. But up to 22% of children over age 3 have GERD symptoms such as heartburn and regurgitation. Most experts say this is usually due to obesity or lifestyle habits. Follow these steps...
Advise parents to limit spicy and acidic foods and drinks, chocolate, and caffeine in their child's diet. Also provide weight management strategies if needed and advise parents to avoid smoking around their children. If these measures fail, consider trying acid-reducing drugs. Use antacids (Gaviscon, Maalox) for occasional symptoms or a trial of an H2-blocker or PPI for daily symptoms.
Famotidine (Antodine, Famotak) is approved for all ages, ranitidine (Zantac, Rani) for children one month and older, BUT withdrawn from pharmacies. Prescribe liquid products for kids who can't swallow the tabs. Lansoprazole (Lanzor, Loral, Zoton), omeprazole (Losec, Omez, Fastcure), and esomeprazole (Nexium, Esomelodan, Esmopump) are also approved for kids one year and older. For kids who can't swallow the PPI caps, suggest mixing the contents with applesauce or use Nexium 10 mg packets for oral suspension. See Table 1 for child dosages for GERD medications.
| Table (1). Child Dosages for GERD Medications | |||
|---|---|---|---|
| MEDICATIONS | DOSAGES | FORMULATIONS | AGES |
| Histamine H2 antagonists | |||
| Cimetidine | 30 to 40 mg per kg per day, divided into 4 doses | Syrup | 16 years or older |
| Famotidine (Rani-F) |
1 mg per kg per day, divided into 2 doses | Sachets | 1 to 16 years |
| Nizatidine (Nizaxid 15 mg/mL) | 10 mg per kg per day, divided into 2 doses | Oral tablets Oral solution |
12 years or older |
| Ranitidine (Zantac, Rani) |
5 to 10 mg per kg per day, divided into 2 or 3 doses | Peppermint-flavored syrup Effervescent tablet |
1 month to 16 years |
| Proton pump inhibitors | |||
| Dexlansoprazole (Dexilant) | 30 to 60 mg daily (adult dose) | Oral tablet | No pediatric indication |
| Esomeprazole (Nexium) | 0.7 to 3.3 mg per kg per day | Sachets Sprinkle contents of capsule onto soft foods |
1 to 17 years |
| Administer capsule contents in juice through nasogastric tube | |||
| Lansoprazole (Zoton) | 0.7 to 3 mg per kg per day | Sprinkle contents of capsule onto soft foods or select juices | 1 to 17 years |
| Administer capsule contents in juice through nasogastric tube | |||
| Strawberry-flavored disintegrating tablet | |||
| Orally disintegrating tablet via oral syringe or nasogastric tube | |||
| Omeprazole (Losec, Nexipro) | 0.7 to 3.3 mg per kg per day | Sachets Sprinkle contents of capsule onto soft foods |
2 to 16 years |
| Pantoprazole (Controloc) | 40 mg daily (adult dose) | Oral tablet | No pediatric indication |
| Rabeprazole (Pariet) | 20 mg daily | Oral tablet | 12 to 17 years |
| Adapted with permission from Lightdale JR, Gremse DA. Gastroesophageal reflux: management guidance for the pediatrician. Pediatrics. 2013; 131(5):e1690. | |||
REFERENCES
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Rudolph CD, Mazur LJ, Liptak GS, Baker RD, Boyle JT, Colletti RB, Gerson WT, Werlin SL; North American Society for Pediatric Gastroenterology and Nutrition. Guidelines for evaluation and treatment of gastroesophageal reflux in infants and children: recommendations of the North American Society for Pediatric Gastroenterology and Nutrition. J Pediatr Gastroenterol Nutr. 2001;32 Suppl 2:S1-31. Available at: https://journals.lww.com/jpgn/Fulltext/2001/00002/Guidelines_for_Evaluation_and_Treatment_of.1.aspx
Hassall E. Decisions in diagnosing and managing chronic gastroesophageal reflux disease in children. J Pediatr. 2005 Mar;146(3 Suppl):S3-12. Available at: https://www.jpeds.com/article/S0022-3476(04)01188-6/fulltextLeung, A.K. and Hon, K.L. (2019). Gastroesophageal reflux in children: an updated review. Drugs in Context, [online] 8. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6586172