Great reflux tips

I forgot about this website, it's a great resource for reflux, doing some research I discovered that maybe we weren't dosing Kaitlyn enough on her reflux meds and the fact that she probably wasn't getting much of the medicine (in solutab form).

I had always heard that Zantac rarely really works for reflux for kids...

Here is some REALLY great Reflux info that I wish I had read more about with Kaitlyn: Thought I'd share. All of this info is from the following website: http://www.marci-kids.com/

1. Regarding h2 blockers (meds like Zantac):
"Tolerance to H2 blockers can occur with prolonged administration; that is, the medication will no longer inhibit acid production, even if the dose is increased. Although your child may feel better at first, the symptoms will often return within one or two weeks, even after increasing the dosage.:

Regarding PPI's (Prevacid, Prilosec)::
Proton pump inhibitors (PPIs) are chemical compounds that irreversibly inactivate the pumps that produce stomach acid.

1.Zegerid powder for oral suspension is the only commercially available immediate-release suspension that is FDA-approved. It is helpful for pediatric use because it is a true suspension that contains no enteric-coated granules that are difficult for young children to ingest. Parents therefore don’t have to worry about their child chewing the granules, which would expose the PPI to stomach acid and reduce the effectiveness of the drug.

2. H2 blockers will prevent PPIs from working if they are taken too close together. For this reason, H2 blockers should not be given within 4 hours of giving a PPI.In-depth look: PPIs work by directly inactivating the acid- producing pumps in the parietal cells, but they can only have this effect if the pumps are actively secreting acid. Because H2 blockers prevent the activation of pumps, they can actually inhibit the ability of a PPI medication to have its effect when they are given at the same time (together). However, giving a PPI in the morning and at midday and then an H2 blocker at bedtime can allow these two classes of medicines to work together (since they are not in the bloodstream/body at the same time).

3. PPIs are often under-dosed in children (see PPI Dosing Information). Because it has been found that children metabolize PPIs more quickly than adults, we recommended administering them 3 times a day for children under 2 years old.

4. If you are currently giving your child a compounded suspension of a PPI such as Prevacid made by a pharmacy, you should know that there is a good potential for the medication to become inactive (and therefore ineffective) in a much shorter time period than your pharmacist may be aware. The loss of activity is related to the effect of the flavorings added by the pharmacies. The flavorings cause the PPI to become unstable and break down so it can no longer inhibit acid secretion. Laboratory testing has shown that the majority of such compounded, flavored preparations become inactive within a week.

In addition, many pharmacies do not add enough buffer in their suspensions to protect the drug from degradation by stomach acid. This is particularly a problem if the child is receiving a very low-volume dose—less than 3 mL, for example—because the amount of buffer likely won't be enough to protect the PPI from degradation by stomach acid.

5. PPI drugs have an effect on the production of acid that is related to the amount of drug that is absorbed into the body. This amount of drug is known as the AUC or area under the curve. So, when planning out a drug regimen with a PPI drug, the best thing to do is to try to achieve the AUC that is known to inhibit enough acid in 24 hrs to reduce damage and reduce symptoms. In other words, you have to give enough PPI--and frequently enough--to get the desired effect. If a PPI is underdosed, the child will continue to suffer from acid reflux and the symptoms may be misdiagnosed. The most revered author in the treatment of reflux in children states in his excellent recent review, “...the most common error in PPI prescribing in children is underdosing. In fact, if the diagnosis in a child is GERD, and there is poor response to PPI, the likely problem is either that an insufficient dose has been used or that the patient is not taking the medication.” -Eric Hassall*

6. Is it possible to give too much PPI?The short answer is no. Fortunately, PPI drugs are very specific in where they work in the body. They are only active in a very specific place – that is the acid secreting cell, parietal cell. Since PPI drugs only work on the acid secreting cell the chance of side effects is very, very low–even if you give 3 times more than your child needs. In fact, PPI drugs are known as prodrugs because they are not active as they pass from the bloodstream to the acid secreting cell. PPIs become active only when they pass into the acid secreting portion of the acid secreting cell, where the pH drops to about 1.


The Marci-kids website has a great dosing calculator on their dosing chart