What omeprazole dose does the British National Formulary for Children recommend for a child weighing 22.6 kg?

Omeprazole Dosing for a 22.6 kg Child

For a child weighing 22.6 kg, the recommended omeprazole dose is 20 mg once daily for symptomatic GERD or erosive esophagitis. 1

Weight-Based Dosing Thresholds

The British National Formulary for Children (BNFC) and American Academy of Pediatrics use weight-based thresholds for omeprazole dosing in children aged 2-16 years:

• Children weighing 10 to <20 kg: 10 mg once daily 1
• Children weighing ≥20 kg: 20 mg once daily 1

Since this child weighs 22.6 kg, they fall into the ≥20 kg category and should receive the 20 mg daily dose. 1

Administration Considerations

• For children unable to swallow capsules: Mix omeprazole pellets with applesauce for easier administration 1
• Timing: Administer once daily, preferably in the morning before meals for optimal acid suppression 2, 3

Dose Escalation for Refractory Cases

If standard dosing proves insufficient after 4-8 weeks of treatment:

• Severe or refractory GERD: May require escalation up to 1.4-2.8 mg/kg/day in divided doses (approximately 32-63 mg/day for a 22.6 kg child) 1
• Eosinophilic esophagitis: Initial treatment is 1 mg/kg twice daily (approximately 23 mg twice daily, up to maximum 40 mg twice daily) 1

Common Pitfalls to Avoid

• Do not use adult dosing: Even though 20 mg is also a common adult dose, the indication here is weight-based pediatric dosing, not age-based adult dosing 1
• Do not underdose: Children at 22.6 kg require the 20 mg dose, not the 10 mg dose used for lighter children 1
• Monitor for side effects: Headaches, diarrhea, and nausea occur in approximately 14% of pediatric patients on prolonged therapy 1

Long-Term Monitoring

For treatment extending beyond 2.5 years, be aware that up to 50% of children may develop enterochromaffin cell hyperplasia, though this is generally reversible upon discontinuation. 1