Can You Give a 10-Year-Old 20 mg Omeprazole?
Yes, 20 mg omeprazole once daily is the appropriate and FDA-approved dose for a 10-year-old child weighing ≥20 kg for treatment of symptomatic GERD or erosive esophagitis. 1
Weight-Based Dosing Criteria
The FDA-approved dosing for pediatric patients aged 2-16 years is determined by body weight, not age alone 1:
Most 10-year-old children weigh more than 20 kg, making 20 mg the standard dose 2. However, if the child weighs less than 20 kg, the dose should be reduced to 10 mg once daily 1.
Approved Indications and Duration
This dosing applies to 1:
- Symptomatic GERD: Up to 4 weeks of treatment
- Erosive esophagitis: 4-8 weeks of treatment (may extend an additional 4 weeks if no response)
- Maintenance of healing: Once daily dosing for up to 12 months in controlled studies
Administration Instructions
Timing and method 1:
- Administer before meals as a single morning dose
- Swallow capsules whole without chewing
- For children unable to swallow capsules: Open capsule, mix pellets with one tablespoon of applesauce, and swallow immediately with cool water without chewing pellets 1
Higher Doses for Refractory Cases
While 20 mg is the standard dose, certain conditions may require higher dosing 2:
- Eosinophilic esophagitis: Initial treatment is 1 mg/kg twice daily (maximum 40 mg twice daily) 2
- Severe refractory GERD: Starting dose of 0.7 mg/kg/day, escalating up to 1.4-2.8 mg/kg/day in divided doses if needed 2, 3
Research demonstrates that approximately 50% of children may require doses higher than the initial 0.7 mg/kg/day to achieve adequate acid control 2. In clinical studies, effective doses ranged from 0.7 to 3.3 mg/kg/day (mean 1.9 mg/kg) for severe esophagitis 3.
Safety Monitoring
Common considerations 2:
- Monitor for headaches, diarrhea, and nausea
- Long-term use (>2.5 years) may cause enterochromaffin cell hyperplasia in up to 50% of children
- Elevated fasting gastrin levels occur commonly but clinical significance in children remains unknown 3
Clinical Pitfalls to Avoid
Do not extrapolate adult dosing directly to children - pediatric dosing is weight-based, not age-based 1. The 20 mg dose is appropriate for children ≥20 kg regardless of whether they are 5 years old or 15 years old, as long as they meet the weight criterion 2.
Verify the child's actual weight before prescribing, as some 10-year-olds may weigh less than 20 kg and require the 10 mg dose instead 1.