Important Supplements
Clicking here will take you to the Selecting Treatment page. This is where you learned about Diet (Breastfeeding and Formula Feeding) and Medicines.
Now you know a bit about the different medications used to treat acid reflux/GERD (from the Medicines page, link provided above). You’ve addressed possible dietary issues (protein intolerances, allergies). It is time to learn about the dosing of these medications, so that you can discuss your baby’s situation with your doctor. It’s also time to learn how to give, or administer, these medications to an infant. Many pediatricians are not comfortable with prescribing high doses of medication to infants. It may be time for a Specialist. Why a Specialist? Just the fact that you’re here, and you’re learning so much, it may be time to find a Pediatric Gastroenterologist, a ped GI. It can be difficult to get an appointment, so, at this point, make the appointment; you can always cancel it if your baby improves by the time the appointment comes up. Please be sure and use the Contact Us form to give feedback about your doctors; please pay it forward!
What is a H2 Blocker? How H2RAs (aka H2 blockers) work: They actually do stop acid production, just not as effectively. They do not coat or sit on top of the acid. The H2R in the name stands for Histamine type 2 Receptor, and the A stands for Antagonist. The parietal cell in the stomach contains the proton pumps, which produce stomach acid. The parietal cell has receptors that recieve the signal to begin acid production. An H2RA blocks the primary receptors, so that the cell does not get this signal. The problem is 1) the body quickly develops a tolerance to these drugs and so they stop working, and 2) the parietal cell has other kinds of receptors that can still receive the message to begin acid production.Zantac, Pepsid, Axid and Tagamet are examples of H2 Blockers, and H2 Blockers DO NOT neutralize acid – only antacids do that (Mylanta for example). H2 blockers work by keeping the acid producing cells (parietal cells) from getting the signal to begin producing acid. Within the parietal cell are the proton pumps, which do the actual work of producing acid. They are the final link in the acid production process. PPIs work by permanently blocking these pumps so that they can no longer produce acid. They are then sloughed off and expelled from the body and replaced by new pumps within 24 hours (less time for infants).
H2 blockers are less effective than PPI for two main reasons:
1) they only block one of three different signals that the parietal cell receives telling it to produce acid, so the signal can still get through.
2) the body develops a tolerance to these drugs very quickly and they soon lose effectiveness when used on a regular basis.
PPIs on the other hand, work by permanently blocking the acid producing proton pumps that are contained in the parietal cells, thus eliminating the last link in acid production. The body does NOT develop a tolerance to PPIs, but they are a weight dependent drug. You may continue to learn more about PPIs by clicking here.
Pounds, Kilograms, Mgs and Mls, Oh My!!?? Your baby’s dose will be based on her weight in kilograms (kgs). Just copy and paste, with your baby’s weight, into google: “[insert number, ex: 10.3] lbs is how kg”. Now you know how many kgs your baby weighs and you’re ready to start calculating doses! When you see “mg/kg” written, this means how many miligrams (mgs) of medicine is needed/given/prescribed for every kg of weight. Here’s an example(!): from my sample of 10.3 lbs, we’ve determined that Sample Baby weighs 4.7 kilos (I rounded up from 4.672 kilos). Using Sample Dose of 10 mgs/kg to explain the proper dosing of Sample Medicine, we see that for every one (1) kg of weight Sample Baby weighs, he should be getting 10 mgs of medicine. So, Sample Baby weighs 4.7 kgs. For Sample Medicine dosage, Sample Baby can have 10 multiplied by 4.7 to find how many mgs of the medication he can have, which is 47 mgs of Sample Medicine. This amount (from this example) is for the whole day; you are going to be giving your baby two, even three doses a day. To do this, you’ll have to divide that total number, 47 in this sample case, into how many doses you’re giving. Most of the time, the doses don’t have to be ‘even’ so you can ‘play’ around with them, perhaps giving a bit of a higher dose in the evening, if nights are worse. Have I lost you? It’s ok, you can always come back!
The last thing to tackle is this: when you see “mg/ml” written, it means how much medicine (measured in mg) is in the liquid (measured in mls) amount you are administering. Phew! Still lost? It’s ok, you’ll get it! Ok, so back to our Sample Baby and Sample Medicine: You’ve figured out that Sample Baby can have 47 mgs of Sample Medicine a day. Great! Next, you look at your Sample Medicine Bottle and it says 15mgs/ml. Now what? This means that for every 1 ml of liquid there is 15 mgs of Sample Medicine. Sample Baby can have 47 mgs of Sample Medicine, hmmm…1 ml is 15 mgs of Sample Medicine, 2 mls is 30 mgs of Sample Medicine; you get the idea. To find your answer, you can continue along in this manner, or, simply take the 47 mgs and divide by 15, which is 3.1. This means Sample Baby can have 3.1 mls of Sample Medicine a day, divided into two or three doses which can be even or ‘uneven’ (you’ll need to consult Sample Doctor and/or Sample Pharmacist for more information).
Histamine H2-receptor antagonists (H2-Blockers)
Always check with your doctor and pharmacist! I will post here the dosing for some H2-Blockers, but make sure to always verify! Your pharmacist has a handy device called the ipharmacist. This is where they look up dosing. Dosing might change, so it’s a good idea to double-check! With H2 Blockers, babies tend to ‘plateau.’ If the medicine was working and it seems to stop working, check the dose and see if it can be increased. These medicines are prescribed by your baby’s weight (and age), so if your baby has gained any weight since first being prescribed her current dose, it most likely can be increased. If your baby has gained weight and the dose is still effective, great! This is a good sign! If your baby is at the highest dose for his weight, he may have developed a tolerance to it and it no longer is as effective as it once was. Always question! I once went to the pediatrician and spouted off my knowledge of Zantac dosing (I was there for my non-refluxer’s ear infection) and she told me I was wrong! She whipped out her Physician’s Reference and showed me lower dosing than what I was telling people! It turns out, I was not wrong; pediatricians (can) go by their dosing and there very well may be another dose recommended for more severe cases. Check! For Zantac: Click here and scroll to the bottom of page 12 (look for ‘Pediatric Use’ and then scroll to ‘Treatment of GERD and Erosive Esophagitis,’ p. 13) for (the highest) Zantac dosing, by weight. You may find that your current dose of zantac may be increased. Research! Scroll through this ‘thread’ on the forum, too, for a discussion of zantac, axid and pepcid dosing. You can check the link out later, as I’m going to go ahead and copy and paste what is found there, to make life easier:
Always check with your doctor and pharmacist! I will post here the dosing for some H2-Blockers, but make sure to always verify! Your pharmacist has a handy device called the ipharmacist. This is where they look up dosing. Dosing might change, so it’s a good idea to double-check! With H2 Blockers, babies tend to ‘plateau.’ If the medicine was working and it seems to stop working, check the dose and see if it can be increased. These medicines are prescribed by your baby’s weight (and age), so if your baby has gained any weight since first being prescribed her current dose, it most likely can be increased. If your baby has gained weight and the dose is still effective, great! This is a good sign! If your baby is at the highest dose for his weight, he may have developed a tolerance to it and it no longer is as effective as it once was. Always question! I once went to the pediatrician and spouted off my knowledge of Zantac dosing (I was there for my non-refluxer’s ear infection) and she told me I was wrong! She whipped out her Physician’s Reference and showed me lower dosing than what I was telling people! It turns out, I was not wrong; pediatricians (can) go by their dosing and there very well may be another dose recommended for more severe cases. Check! For Zantac: Click here and scroll to the bottom of page 12 (look for ‘Pediatric Use’ and then scroll to ‘Treatment of GERD and Erosive Esophagitis,’ p. 13) for (the highest) Zantac dosing, by weight. You may find that your current dose of zantac may be increased. Research! Scroll through this ‘thread’ on the forum, too, for a discussion of zantac, axid and pepcid dosing. You can check the link out later, as I’m going to go ahead and copy and paste what is found there, to make life easier:
Recommended dosing of Zantac (also called Ranitidine)
Duodenal and gastric ulcer: children 1 month to 16 years: 2-4 mg/kg/day divided twice daily to a maximum dose of 300 mg/day
GERD and erosive esophagitis: children 1 month to 16 years: 5-10 mg/kg/day divided twice daily.
Duodenal and gastric ulcer: children 1 month to 16 years: 2-4 mg/kg/day divided twice daily to a maximum dose of 300 mg/day
GERD and erosive esophagitis: children 1 month to 16 years: 5-10 mg/kg/day divided twice daily.
GERD max dosage: 300 mg/day. Erosive esophagitis max dosage: 600 mg/day
Recommended dosing of Axid (also called nizatidine) for the treatment of GERD in infants and children:
Children <12 years: 10mg/kg/day divided into two daily doses.
However, Lexi-Drugs states that Axid may not be as effective in children under the age of 12 years as it is for adults and children 12 years and older.
Children <12 years: 10mg/kg/day divided into two daily doses.
However, Lexi-Drugs states that Axid may not be as effective in children under the age of 12 years as it is for adults and children 12 years and older.
Children >12 years: 150 mg twice a day
Recommended dosing of Pepcid (also called Famotidine) in the treatment of GERD in infants and children:
Infants < 3 months: 0.5 mg / kg / dose given once daily
Infants 3 – 12 months: 0.5 mg / kg / dose given twice daily
Children 1 – 12 years: 0.5 mg / kg / dose given twice daily (maximum of 80 mg / day)
Infants < 3 months: 0.5 mg / kg / dose given once daily
Infants 3 – 12 months: 0.5 mg / kg / dose given twice daily
Children 1 – 12 years: 0.5 mg / kg / dose given twice daily (maximum of 80 mg / day)
NOTE: The information on this page is not exhaustive and complete accuracy is not guaranteed. Please consult your doctor with any questions you may have regarding the treatment of your child.
