Pharmacologic Therapy for Gastroesophageal Reflux Disease in Children

Most children with gastroesophageal reflux have normal weight gain, minimal irritability, and no respiratory symptoms.1 GERD occurs when reflux symptoms are more severe or when complications arise.2 The classic picture of infantile GERD is an irritable baby with poor weight gain and arching of the back during feeding, but symptoms may also include wheezing or coughing.1,2 The authors of this Cochrane review evaluated 24 RCTs examining pharmacologic management of GERD in children younger than 16 years. Currently, ranitidine is the only antacid approved by the U.S. Food and Drug Administration for infants younger than 12 months.1 The authors concluded that there is weak evidence to support the use of PPIs and H2 antagonists in infants younger than 12 months. Gaviscon Infant is a preparation of sodium and magnesium alginate that reportedly acts as a thickener to mitigate gastric acid. Because of toxicity concerns, it was reformulated in 1999 as an aluminum-free compound.