Maximum Omeprazole Dose for a 16 kg Child
For a 16 kg child, the maximum dose of omeprazole is 20 mg twice daily (total 40 mg/day) when treating eosinophilic esophagitis, or 10 mg once daily for standard GERD/erosive esophagitis. 1, 2, 3, 4
Standard FDA-Approved Dosing
For children aged 2-16 years weighing 10 to less than 20 kg (which includes your 16 kg patient):
- Symptomatic GERD: 10 mg once daily for up to 4 weeks 4, 3
- Erosive esophagitis: 10 mg once daily for 4-8 weeks 4, 3
- Maintenance of healing: 10 mg once daily (controlled studies don't extend beyond 12 months) 4, 3
This represents the standard maximum for typical acid-related conditions in this weight range. 4
Higher Dosing for Specific Conditions
For eosinophilic esophagitis specifically, substantially higher doses are appropriate and evidence-based:
- Initial treatment: 1 mg/kg twice daily (up to maximum 40 mg twice daily) 1, 2
- For a 16 kg child, this calculates to 16 mg twice daily (32 mg/day total) 1
- The guideline explicitly states "up to 40 mg twice daily" as the maximum, meaning your 16 kg patient could receive up to 20 mg twice daily if needed 1, 2
- Treatment duration should be 8-12 weeks before assessing histological response 1, 2
The higher dosing regimen (omeprazole 20 mg twice daily or equivalent) has demonstrated superior response rates (50.8%) compared to standard doses (35.8%) for eosinophilic esophagitis. 1, 2
Severe Refractory GERD in Younger Children
For infants and children under 2 years with severe or refractory GERD (though your patient is likely older):
- Starting dose: 0.7 mg/kg/day 3, 5, 6, 7
- May escalate to: 1.4-2.8 mg/kg/day in divided doses 3, 5
- For a 16 kg child, this would translate to 11.2 mg/day starting dose, escalating up to 44.8 mg/day if needed 5
Research demonstrates that children under 2 years may require doses ranging from 0.7 to 3.3 mg/kg/day (mean 1.9 mg/kg) for adequate reflux control, with some requiring up to 2.8 mg/kg/day. 5, 6
Clinical Decision Algorithm
Choose your maximum dose based on indication:
Standard GERD or erosive esophagitis: Maximum 10 mg once daily 4, 3
Eosinophilic esophagitis: Maximum 20 mg twice daily (40 mg/day total) 1, 2
Severe refractory GERD with documented inadequate response: May escalate up to 2.8 mg/kg/day (44.8 mg/day for 16 kg child) in divided doses, guided by pH monitoring 5, 6
Important Caveats
- Weight-based dosing on a per-kilogram basis is much greater in children than adults to achieve equivalent acid suppression 7
- Doses should be titrated based on clinical response and, ideally, 24-hour pH monitoring for refractory cases 5, 6
- Once an effective dose is established for conditions like eosinophilic esophagitis, doses should not be reduced in primary care 2
- Long-term use (>2.5 years) may be associated with enterochromaffin cell hyperplasia in up to 50% of children 3
- Monitor for elevated gastrin levels with chronic use, though clinical significance in children remains uncertain 6
Administration for This Weight
For a 16 kg child unable to swallow capsules, open the capsule and mix pellets with one tablespoon of applesauce, then swallow immediately without chewing the pellets. 4, 3