Baby reflux medicines are often given when a baby may not need medication at all, or when other non-drug steps can help. Reflux medicines (aka Proton Pump Inhibitors or PPIs) are among the most overused drugs in the world, making the list of top ten most prescribed drugs. If your baby or child is on a reflux medicine, your gastroenterologist (GI doctor) probably prescribed it to lower stomach acid for presumed gastroesophageal reflux disease (GERD). Learn more here about why GERD isn’t a disease at all, and may not need treatment.
While these drugs are considered generally well-tolerated and are not considered harmful to adults or even children, the problem is that giving a baby reflux medicine is only approved for very short term use. The same is true for giving reflux medicines to children over a year old. But, it’s common to leave babies, toddlers or older children on them for months or even years at a time. I see this in my pediatric nutrition practice all too often! When these drugs are taken for months at a time, there is potential for serious side effects that can cause lasting digestive and immune system issues. I have encountered a number of cases of children who started reflux medicines in infancy and continued on them for years.
Another issue with giving a baby reflux medicine for GERD symptoms is that the diagnosis is typically based on a brief conversation with mom about spit up, colic, or vomiting. Rarely seen is an actual diagnostic test for whether someone meets criteria for truly needing this medicine. Measuring stomach acid can be a confirming diagnostic for “excess stomach acid”. This requires using a probe to actually measure pH in the stomach, which can be performed during an endoscopy under sedation or anesthesia. If inflammation, damage, eosinophilic infiltration, or cobbling is seen in the esophageal tissue during that procedure, excess stomach acid is the presumed cause.
Another way to confirm whether someone actually needs reflux medicine to control acid reflux into the esophagus is to observe stomach acid actually entering the esophagus (that is, stomach contents are going up instead of down) with a barium swallow test. This is done live in real time and viewed on X ray.
It’s rare for these tests to be performed on infants, and it’s common for parents to want a quick fix for a baby’s distress. But medicating a baby for reflux may or may not help. For our first six months, we haven’t developed enough stomach acid to digest food very efficiently. Stomach acid at birth is weak, too weak to process big volumes into the small intestine. And a baby’s stomach is really tiny! At birth, the baby’s stomach capacity is about a tablespoon – that’s it. It’s normal for babies to have some reflux, spit up, and colic. Working through this with natural supports can help ease discomfort, while allowing the normal progression of digestive skills to evolve.
Baby reflux medicines can stall this process, by keeping the stomach buffered all the time. This is exactly how many of my young patients end up needing more, more, and more reflux medicine… until it stops working even at the highest dose.
Here’s When To Intervene
Babies normally have some spit up or vomiting. If your baby is clearly in pain, crying hard, unable to eat, and not growing or gaining, then a baby reflux medicine can offer some temporary relief. Likewise, if your doctor saw highly irritated esophageal tissue on an endoscopy, then a short term use of reflux medicine may be necessary to soothe the situation. Babies should not be left to cope with pain when a medication can immediately help.
Create a strategy up front with your doctor to use those tools temporarily. A switch in feeding can often make a big difference. Changing a breastfeeding mom’s diet can help, by removing foods like dairy, eggs, or high FODMAPs foods like onions, garlic, apples, prunes, or broccoli.
Formula fed babies can improve with a switch to something more digestible. Switch off cow’s milk formulas and try a hydrolyzed (partly digested) protein option like Bobbie Organic Gentle Infant Formula, made with lactose (just like breast milk for the carbohydrate source) and hydrolyzed whey. Some families in my practice rave about hydrolyzed formulas like Alimentum Ready To Feed (downside: Not organic), or formulas with a different protein profile like Gerber Soothe (more whey, less casein), or a goat milk formula option (organics now available). All of these are worthy measures before placing your baby on a reflux medicine.
There are also gentle herbal glycerite tinctures for children that soothe the stomach and gently encourage normal digestive function. One of my favorites is Gaia Herbs Tummy Tonic, which I’ve used with success for many years in my pediatric nutrition practice. This herbal tincture is one of may herbal blends known as digestive bitters. They gently stimulate the stomach to produce its own normal array of acids so digestion can begin.
Since reflux drugs lower stomach acid, they also lower the protection we get from having that natural acidic barrier between the big bad world and our bodies. This acid barrier is supposed to be very acidic. A gastric juice pH as low as 1.0 is normal. This can prevent harmful bacteria that may be in our mouths from entering the body. But if the stomach pH gets too high – that is, if it becomes less acidic – this matters for 3 key reasons:
- Potentially harmful oral bacteria can work its way into lower parts of the GI tract, a trip that would not be made possible when there is enough stomach acid. Once it makes its way into the GI tract, foreign bacteria can cause such infections as Clostridium difficile, Salmonella, Campylobacter as well as Escherichia coli.
- When harmful bacteria invade the GI tract, they can begin to overgrow and compete with the “good bacteria” that we rely on to help us with digestion and immune system support. Over time this impacts the diversity of our microbiome and can cause dysbiosis, a condition where the good bacteria is reduced and too much bad bacteria is allowed to grow – creating an environment that can also lead to yeast overgrowth, constipation, irritable loose stools, picky eating, food intolerances, food allergies, or pain.
- Too much of the wrong kind of bacteria and not enough of the good kind can lead to inflammation in the gut, which then cause the gut wall barrier to be more permissive – that is, the tightly compacted tissue structure inside the gut wall gets a little loose, with microscopic spaces that can allow larger molecules than normal to enter circulation in the body. These can be partly digested food proteins, toxins, or microbial organic acids. This is known as “leaky gut” and people may experience all sorts of discomfort or chronic systemic inflammation as a result.
My baby was treated with a reflux medicine. Now what?
Long term use of reflux medicine can disrupt healthy gut microbiomes, favoring yeast or fungal species or dysbiotic gut bacteria that don’t support good digestion and absorption. Over time, giving a baby reflux medicine can make weak, picky appetites, weak protein digestion, weak absorption of minerals like iron and zinc, and poor B12 absorption. Here are six steps to correct course and help restore appetite:
- Step 1 – Make a plan with your doctor to wean your baby or toddler off reflux medicine. Review and update lab tests or endoscopy if necessary.
- Step 2 – Assess gut microbiome with a functional stool study test. In my years of pediatric nutrition practice, I have consistently found that non-pathogen, dysbiotic microbe species are often in the mix, when it comes to reflux, colic, and misery with feeding. I also often see that beneficial species are depleted at the same time. Sub-clinical levels of Helicobacter pylori, Clostridia difficile, Dientameoba fragilis, Candida species, and others show up often on PCR DNA stool tests. My preferred clinical resource for this screening is Diagnostic Solutions Lab GI MAP, though there are other offerings out there. Many of these tests include measures for inflammation and digestive function too. This is an easy way to sort out what is going on. Work with an experienced integrative and functional practitioner when ordering your child’s stool test. Build a gentle, effective protocol with herbal supports, foods, and probiotics so a healthy, comfortable, and supportive gut microbiome can evolve. This will restore normal digestion in many cases. If your doctor doesn’t offer this testing, work with me here.
- Step 3 – Change up your baby’s feeding routine per suggestions above. Find an easy to digest formula. If your baby is adding solids, start with low FODMAPs fruits, vegetables, and grains, plus gentle protein sources like white fish, chicken, or turkey. Avoid fermented foods or bulky high fiber foods at first; these may become easier to handle later on.
- Step 4 – Avoid high potency multi strain probiotics at first. Start with a simple one like Klaire Factor 1 or Klaire ABx Support (use ABx Support no longer than 28 days). More complex products like Seeking Health HistaminX may be better tolerated later on.You can order these in my practice dispensary here. Set up your own account and then search by product name.
- Step 5 – Gently restore stomach acid with a combination of a digestive bitters tincture like Wise Women Herbals Tummy Glycerite. This is also available in my dispensary, and I’ve used it often in infants and young children as a gastric stimulant and support. Start with a quarter or half dose to test tolerance. Then use it with feedings or meals at least twice daily, ongoing. Watch for a gentle shift away from reflux features.
- Step 6 – Use gastric soothers and herbs that gently enhance acid, stimulate digestive juices, and soothe irritated tissue:
- 1/4 teaspoon Braggs Apple Cider Vinegar between meals with water or any juices
- A few drops of lemon juice or lemon wedge in your child’s water bottle throughout the day
- Peeled ginger root slices in tea, water, or cooked foods your child eats; this is a good addition to congee, a great food for babies!
- Peppermint or chamomile tea
- Blends like GI Revive offer an option for soothing irritated gut tissue for children past infancy, and can be used with supervision from your knowledgeable naturopathic provider. Marshmallow root, aloe, licorice root, slippery elm or fennel are good supports for this; see my FullScript platform and contact me if you need help with this measure.
Give this project some time, especially for kids and babies alike who have used a reflux medicine for more than 3-4 months. A healthy appetite without bloating, hiccups, gas, constipation or pain can be restored!