From the Guidelines
For a 10-year-old with GERD, I recommend starting with lifestyle modifications before medication, as these changes can significantly reduce symptoms and improve quality of life 1. These lifestyle modifications include:
- Elevating the head of the bed to reduce acid reflux during sleep
- Avoiding meals 2-3 hours before bedtime to decrease nighttime symptoms
- Limiting acidic foods, chocolate, caffeine, and fatty foods that can trigger reflux
- Maintaining a healthy weight to reduce pressure on the stomach and lower esophageal sphincter If symptoms persist, medication therapy should begin with an H2 receptor antagonist such as ranitidine (2-4 mg/kg/day divided twice daily, maximum 300 mg/day) for 4-8 weeks, as recommended by the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition 1. For more severe cases, a proton pump inhibitor like omeprazole (10-20 mg daily) or lansoprazole (15-30 mg daily) may be needed for 8-12 weeks, as these medications have been shown to be effective in reducing acid exposure and preventing complications like esophagitis or strictures 1. Antacids can provide quick symptom relief but should be used sparingly, as they can have adverse effects and interact with other medications 1. If symptoms don't improve with medication, or if there are warning signs like weight loss, dysphagia, or persistent vomiting, referral to a pediatric gastroenterologist is warranted for further evaluation, possibly including endoscopy, to rule out other underlying conditions and prevent long-term complications 1.
From the FDA Drug Label
One year to 11 years of age In an uncontrolled, open-label, US multicenter study, 66 pediatric patients (one year to 11 years of age) with GERD were assigned, based on body weight, to receive an initial dose of either lansoprazole 15 mg daily if ≤30 kg or lansoprazole 30 mg daily if greater than 30 kg administered for eight to 12 weeks The lansoprazole dose was increased (up to 30 mg twice daily) in 24 of 66 pediatric patients after two or more weeks of treatment if they remained symptomatic. At baseline 85% of patients had mild to moderate overall GERD symptoms (assessed by investigator interview), 58% had non-erosive GERD and 42% had erosive esophagitis (assessed by endoscopy) After eight to 12 weeks of lansoprazole treatment, the intent-to-treat analysis demonstrated an approximate 50% reduction in frequency and severity of GERD symptoms. Twenty one of 27 erosive esophagitis patients were healed at eight weeks and 100% of patients were healed at 12 weeks by endoscopy
For a 10-year-old patient with GERD, the recommended treatment is lansoprazole. The initial dose should be based on body weight:
- 15 mg daily if the patient weighs ≤30 kg
- 30 mg daily if the patient weighs >30 kg The dose can be increased up to 30 mg twice daily if the patient remains symptomatic after two or more weeks of treatment. The expected outcome is a reduction in frequency and severity of GERD symptoms, with approximately 50% of patients experiencing improvement after 8-12 weeks of treatment. Healing rates for erosive esophagitis are also expected, with 21 out of 27 patients healed at 8 weeks and 100% healed at 12 weeks. 2
From the Research
Treatment Options for GERD in a 10-Year-Old
- The treatment of GERD in children can be managed with lifestyle modifications and medical therapy, including proton pump inhibitors (PPIs) and histamine(2) receptor antagonists 3.
- PPIs have been shown to be effective in relieving heartburn symptoms in patients with GERD, with a relative risk of heartburn remission of 0.37 in placebo-controlled trials 4.
- Lansoprazole, a PPI, has been shown to be safe and effective for the treatment of acid-related disorders, including GERD, and is comparable to omeprazole in terms of efficacy 5.
- A study comparing four therapeutic strategies for heartburn found that proton pump inhibitor treatment provides more consistent heartburn relief than an H2-receptor antagonist, or "step-up" or "step-down" therapy 6.
Medical Management of GERD
- The American Society for Gastrointestinal Endoscopy recommends medical management, including PPIs, for patients with symptomatic and confirmed GERD with predominant heartburn symptoms 3.
- PPIs should be used at the lowest dose for the shortest duration possible, while initiating discussion about long-term management options 3.
- Combination therapy with PPIs and histamine(2) receptor antagonists has not been shown to provide any further benefit above that derived from PPIs alone in patients with GERD 7.