From the Guidelines
For a 4-year-old child, a dose of 0.7 to 3.3 mg/kg daily of a proton pump inhibitor (PPI) such as omeprazole is recommended, based on improvement in clinical symptoms and esophageal pH monitoring results 1. When considering PPI therapy for a child, it's essential to weigh the benefits against potential risks, particularly in infants who may be at increased risk of lower respiratory tract infections 1. Some key points to consider when prescribing PPIs for children include:
- The efficacy of PPIs in treating severe esophagitis and esophagitis refractory to H2RAs in children, with studies showing improvement in GERD symptoms and healing of erosive esophagitis 1
- The safety profile of PPIs, which are generally well-tolerated with relatively few adverse effects, although headaches, diarrhea, constipation, and nausea have been reported in up to 14% of older children and adults 1
- The importance of using the lowest effective dose and avoiding overuse or misuse of PPIs, particularly in infants, where placebo-controlled trials have not demonstrated superiority of PPIs over placebo for reduction in irritability 1
- The need for careful consideration of the duration of treatment, which typically ranges from 4-8 weeks for GERD or ulcers, although some conditions may require longer therapy 1.
From the FDA Drug Label
The pharmacokinetics of lansoprazole were studied in pediatric patients with GERD aged less than 28 days and one to 11 months. Compared to healthy adults receiving 30 mg, neonates had higher exposure (mean weight-based normalized AUC values 2.04 and 1.88 fold higher at doses of 0. 5 and 1 mg/kg/day, respectively). Infants aged ≤10 weeks had clearance and exposure values that were similar to neonates. Infants aged greater than 10 weeks who received 1 mg/kg/day had mean AUC values that were similar to adults who received a 30 mg dose Patients received lansoprazole as a suspension daily (0.2 to 0.3 mg/kg/day in infants ≤10 weeks of age or 1.0 to 1. 5 mg/kg/day in infants greater than 10 weeks or placebo) for up to four weeks of double-blind treatment. 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
For a 4-year-old child, the dose of lansoprazole would be based on their weight.
- If the child weighs ≤30 kg, the initial dose would be 15 mg daily.
- If the child weighs >30 kg, the initial dose would be 30 mg daily. 2
From the Research
Dosage of PPI for a 4-year-old child
- The dosage range for PPIs in children varies depending on the specific medication and the condition being treated 3.
- For lansoprazole, the dosage range is 0.73-1.66 mg/kg/day, with a maximum dose of 30 mg/day 3.
- For omeprazole, the dosage range is 0.3-3.5 mg/kg, with a maximum dose of 80 mg/day 3.
- The dosage range for omeprazole used for H. pylori eradication is 0.5-1.5 mg/kg/day, with a maximum dosage of 40 mg/day 3.
- For a 4-year-old child, the exact dosage would depend on their weight and the specific condition being treated, but as a general guideline, the dosage could be calculated based on the above ranges.
Considerations for PPI use in children
- PPIs are generally effective and well-tolerated in children, but long-term tolerability studies are needed, particularly in the pediatric population 3.
- Adverse effects of PPIs in children are relatively rare, but can include respiratory tract complications, gastrointestinal complications, and urinary tract infections 4.
- The choice of PPI and dosage should be individualized based on the child's specific needs and medical history 5, 6, 7.