From the Guidelines
Treatment for infantile reflux typically begins with conservative measures, including lifestyle modifications and feeding changes, rather than medication, to minimize potential harm and maximize quality of life. The most recent and highest quality study 1 suggests that conservative measures such as keeping the baby upright for at least 30 minutes after feeding, elevating the head of the crib by about 30 degrees, and smaller, more frequent feedings can help alleviate symptoms. Additional measures include:
- Thickening breast milk or formula with rice cereal, but with caution due to the potential risk of necrotizing enterocolitis in preterm infants 1
- Eliminating dairy from the mother's diet if breastfeeding 1
- Trying anti-reflux formulas for bottle-fed babies 1
- Avoiding overfeeding, frequent burping during feeding, and upright positioning in the caregiver’s arms after feeding 1 It's essential to consult a pediatrician if reflux persists, causes weight loss, or is accompanied by other concerning symptoms like projectile vomiting or blood in the stool, as these may indicate a more severe condition requiring medical attention 1. Most infants outgrow reflux by 12-18 months of age, and treatment is aimed at managing symptoms until this occurs naturally, prioritizing the infant's morbidity, mortality, and quality of life above all else.
From the FDA Drug Label
Omeprazole delayed-release capsules are used in adults: • for up to 4 weeks to treat heartburn and other symptoms that happen with gastroesophageal reflux disease (GERD). For children 2 to 16 years of age, omeprazole delayed-release capsules are used: • for up to 4 weeks to treat heartburn and other symptoms that happen with gastroesophageal reflux disease (GERD). • for up to 8 weeks to treat gastroesophageal reflux disease (GERD) with acid-related damage to the lining of the esophagus [called erosive esophagitis (or EE) due to acid-mediated GERD]
The treatment for Gastroesophageal Reflux (GER) in infants is not directly stated in the provided drug labels. However, for children 2 to 16 years of age, omeprazole delayed-release capsules are used for up to 4 weeks to treat heartburn and other symptoms that happen with GERD. Since infants are not explicitly mentioned, it is unclear if omeprazole can be used to treat GER in this age group. Lansoprazole is indicated for short-term treatment in pediatric patients one to 11 years of age (up to 12 weeks) for the treatment of heartburn and other symptoms associated with GERD. However, neither label provides information on the treatment of GER in infants. 2 3
From the Research
Treatment for Gastroesophageal Reflux (GER) in Infants
The treatment for GER in infants can be divided into several categories, including:
- Non-pharmacologic management strategies, such as lifestyle changes and feeding modifications 4, 5, 6, 7
- Pharmacologic therapy, including antisecretory agents, antacids, surface barrier agents, and prokinetics 4, 5, 8
- Surgical treatment, which is typically reserved for severe cases of GERD that do not respond to medical therapy 4, 5
Non-Pharmacologic Management Strategies
Non-pharmacologic management strategies for GER in infants include:
- Body position changes while awake, such as keeping the infant upright after feedings 5
- Lower-volume feedings, which can help reduce the amount of gastric contents that flow back up into the esophagus 5
- Thickening agents, such as rice cereal, which can help thicken the formula and reduce regurgitation 5, 6
- Antiregurgitant formula, which can help reduce the amount of gastric contents that flow back up into the esophagus 5
- Eliminating cow's milk and eggs from the mother's diet, which can help reduce symptoms of GERD in breastfed infants 4, 5
Pharmacologic Therapy
Pharmacologic therapy for GER in infants includes:
- Antisecretory agents, such as esomeprazole, which can help reduce the amount of acid produced in the stomach 4
- Antacids, which can help neutralize stomach acid and reduce symptoms of GERD 8
- Surface barrier agents, which can help protect the esophagus from stomach acid and reduce symptoms of GERD 4
- Prokinetics, which can help strengthen the lower esophageal sphincter and reduce symptoms of GERD 4, 8
Surgical Treatment
Surgical treatment for GER in infants is typically reserved for severe cases of GERD that do not respond to medical therapy, and may include procedures such as Nissen fundoplication 4, 5. However, the role of surgery in the treatment of GERD in infants is still unclear, and more research is needed to determine its effectiveness and safety in this population.