Is Mylanta Appropriate for an 11-Year-Old?
No, chronic antacid therapy including Mylanta (aluminum hydroxide and magnesium hydroxide) is generally not recommended to treat GERD in children, and the FDA labeling for magnesium hydroxide products directs children under 12 years to "ask a doctor" before use. 1, 2
Why Antacids Are Not Recommended for Pediatric GERD
Chronic antacid use carries significant concerns in children and should be avoided as a treatment strategy. 1 The American Academy of Pediatrics explicitly states that chronic antacid therapy is generally not recommended for treating GERD in pediatric patients due to safety risks. 1
Key Limitations of Antacids in Children:
Limited evidence of efficacy: While historical data suggests on-demand antacid use may provide symptom relief, antacids are generally viewed as having insufficient evidence for routine pediatric GERD management. 1
FDA labeling restrictions: The FDA-approved labeling for magnesium hydroxide (a key component of Mylanta) specifically states that children under 12 years should "ask a doctor" before use, indicating this is not an over-the-counter recommendation for this age group. 2
Drug interaction concerns: Antacids can interfere with absorption of other medications, limiting their use in children who may be on multiple therapies. 3
What Should Be Used Instead for an 11-Year-Old
For an 11-year-old with GERD symptoms, the evidence-based approach prioritizes lifestyle modifications first, followed by acid suppressants (H2-receptor antagonists or proton pump inhibitors) if pharmacotherapy is needed. 1, 3
Treatment Algorithm for an 11-Year-Old:
First-line approach - Lifestyle modifications: 1, 3
- Weight loss if needed
- Avoiding trigger foods
- Not smoking or using alcohol
- Chewing sugarless gum
- Positioning changes (elevating head of bed)
Second-line - Pharmacotherapy if lifestyle changes fail: 1, 3
For mild, intermittent symptoms:
- Famotidine 1 mg/kg/day divided in 2 doses (FDA-approved for ages 1-16 years) 1, 3
- Available as cherry-banana-mint flavored oral suspension for easier administration 1
- Caveat: Develops tachyphylaxis within 6 weeks, limiting long-term effectiveness 1, 3
For moderate to severe symptoms or erosive esophagitis:
- Omeprazole 0.7-3.3 mg/kg/day (FDA-approved for ages 2-16 years) 1, 3
- Should be given approximately 30 minutes before meals for optimal effect 3
- More effective than H2-receptor antagonists for symptom relief and healing erosive esophagitis 3
- Caveat: Long-term use may increase risk of respiratory infections and should not exceed 4-8 weeks without reassessment 3
Third-line - Refractory cases: 3
- Switch from famotidine to omeprazole if no response after 2-4 weeks
- Increase omeprazole dose up to 3.3 mg/kg/day if partial response
- Consider referral to pediatric gastroenterologist
Common Pitfalls to Avoid
Do not use antacids as chronic therapy in children. While a single dose for acute symptom relief might be considered under physician guidance, regular use is not supported by guidelines and carries the risks outlined above. 1
Do not prescribe acid suppressants without first attempting lifestyle modifications, as these are effective and avoid medication-related risks. 1, 3
Be aware that all acid suppressants carry risks: H2-receptor antagonists and proton pump inhibitors may increase risk of community-acquired pneumonia, gastroenteritis, and candidemia in pediatric patients. 1, 3 This makes appropriate patient selection and duration of therapy critical.