My Baby Has Reflux – Now What?

By Cyndra Neal

You’ve just come back from your pediatrician with a diagnosis of reflux for your baby and a prescription for an acid reflux medication in your hand. Now’s the time to do some research into the different types of reflux medications prescribed for infants, how they work and are they safe for your infant.

Your prescription is most likely for an antacid, H2 blocker or a Proton Pump Inhibitor (PPI). The antacids such as Maalox or Mylanta neutralize acids while the H2 blockers and the PPIs suppress the production of acid in the stomach.

H2 blockers include:

• Tagamet (cimetidine)
• Pepcid (famotidine)
• Axid (nizatidine)
• Zantac (ranitidine)

Cells in the stomach lining called parietal cells are stimulated in a number of ways to produce acid. One of these methods is through the chemical histamine2 which signals the stomach to make acid. H2 blockers also referred to as H2-receptor antagonists suppress acid production by blocking the signals of histamine2 to the parietal cells. Proton pump inhibitors work in a different way by completely blocking the production of acid. A molecule in some cells of the stomach, pump acid into the stomach by taking a non-acidic potassium ion out of the stomach and replacing  it with an acidic hydrogen ion. The more hydrogen ions in your stomach, the more acidic the stomach becomes.  PPIs stop the secretion of acid into the stomach by stopping the action of the proton pump.

PPIs include:

• Aciphex (raberprazole)
• Nexium (esomeprazole)
• Prevacid (lansoprazole)
• Prilosec (omeprazole)
• Protonix (pantoprazole)

Histamine blockers and PPI’s work on different phases of acid production. Histamine blockers work on the beginning stages by blocking one of the first stimuli for acid while PPI’s result in greater suppression of acid by inhibiting the final step of acid secretion. H2 blockers begin working within an hour but only are effective for about 12 hours. PPI’s work for a longer period of time, usually up to 24 hours, but take longer to start working and the effects can last up to 3 days.

Another group of medicines that were extremely popular prescriptions for infants are called prokinetic agents. These worked by helping move out the stomach contents quickly and tighten the lower esophageal sphincter so stomach acid would be less likely to wash back up into the esophagus. Propulsid and Reglan which fall into this category were found to have dangerous side effects. Propulcid is now no longer used due to deaths associated with it and Reglan has shown to have an increased risk of neurological side effects in children.

Most commonly prescribed for infants today are Zantac (H2 blocker) and Prevacid (PPI). Both are strong drugs and although well tolerated by most children, can produce side effects as well as drug interactions. Renowned pediatrician and author Dr. Greene writes about Zantac on his website:

“I’ve begun to hear about doctors who prescribe Zantac for almost any fussy baby. This is unwise. While side effects are uncommon, this is a strong drug that alters the normal secretions of the cells of the stomach wall. I agree with thoughtful use of Zantac. It should not be dispensed like candy.”

Many babies will find relief with a few lifestyle adjustments or natural remedies:

• Feed babies in an upright position.
• Elevate the head of your baby’s bed by 30 degrees.
• Feed more frequently with smaller amounts.
• If you are breast feeding, try avoiding certain foods such as caffeine, garlic and chocolate.
• Slouching in an infant seat can encourage reflux by causing compression of the abdomen.
• Try to burp your infant several times during the feeding – it will help minimize gastric pressure.
• Natural remedies without baking soda can help safely reduce reflux that can also be caused by gas due to improper feeding techniques or milk and formula intolerance.

A certain amount of spit-ups are normal for infants as the digestive system is maturing. If your child is suffering from GERD or severe acid reflux, prescription drugs may be needed but some pediatricians use reflux meds as a way to placate the parents. Making sure that you are an informed participant in the treatment of your child can make all the difference in your baby’s health.