Our pediatrician prescribed Bethancol, is it safe for my baby?

In our opinion, motility or prokinetic drugs such as Bethancol should only be used when there is medical confirmation of Delayed Gastric Emptying (DGE). While the use of these medications will speed digestion, they do not alter the pH of the acid reflux. Bethancol can cause side effects including those that affect the Central Nervous System. Ultimately, it’s not the best option to treat infants with acid reflux without diagnosis of gastroparesis.

How safe is Reglan for my infant’s acid reflux?

Reglan is also a motility drug and should only be used with confirmation of DGE and no other treatment is helping. Because Reglan has a black box label by the FDA and a high possibility of irreversible side effects, we suggest exhausting all other options before deciding to use Reglan.

What is acid rebound and when does it occur?

Acid rebound occurs when you eliminate a Proton Pump Inhibitor (PPI) medication or even when you reduce the acid reflux medication. It happens because Gastrin, a hormone the body produces, sets the body into overdrive creating acid. To avoid acid rebound, please see our suggestions on a medication wean.

How long is the PPI in my baby’s system?

The PPI will stay in the system for approx. 120 minutes after being dosed. If the acid pumps (proton pumps) are not on during that time period then acid will not be blocked. Immediate release PPIs (such as Zegerid), have a buffer in them that turns on the acid pumps (in addition to protecting the PPI from acid degradation). This is why immediate release PPIs can be given without regard to meals (or even in the bottle).

Why do some acid reflux meds need to be given on an empty stomach at least 30 minutes prior to a meal?

Delayed release PPIs need to be given on an empty stomach, about 30 minutes to 1 hour before a meal to ensure that they reach the duodenum; where the enteric-coated granules are absorbed. If they are taken with food, the pH of the food (such as milk) can result in early disintegration of the enteric-coating (because it is pH sensitive). When this happens, the medication becomes ineffective.

We were just prescribed a compounded medicine and I was told it is good for 30 days, is this true?

No. What happens with the compounded formulations is that they begin to break down on day 1, but it takes until day 5 when they go below 90%. Ninety percent (90%) is the maximum allowed breakdown by the FDA. Once the breakdown falls below 90% (day 6 and beyond) it continues to breakdown. So, yes, at 30 days, there is still some medication in the compound (about 10-15%); however, the part of the medication that is broken down (the degradation products) can now cause excess gas production (we call such the “belly bomb”), acid stimulation, and mucousy poop. Studies show that lansoprazole (prevacid) and omeprazole (prilosec) suspensions are actually only stable for approximately 5 days. For more information on the studies of the stability of these medications, please contact us.

Will Axid or Zantac work for my baby’s acid reflux?

In mild cases of acid reflux, yes. However, these medications (which are called H2 Blockers) are very weight sensitive and babies often build a tolerance to these medications within 7-10 days.

Our pediatrician told us to switch formulas, how long before I see results?

Anytime you change infant formula you should give it a full two weeks. If you are dealing with acid reflux, in addition to MSPI, do be aware that a temporary acid reflux “flare” is most likely going to occur. If you are dealing with reflux alone, it is unlikely that a fomula change will have little effect; rather, it may cause more disruption than help.

When does reflux tend to flare?

Unfortunately acid reflux can flare with shots, teething, sickness, a diet change and developmental milestones. ‘Tis the beast of the reflux roller coaster!

Do I wait 30 minutes before feeding after giving my baby an H2?

While it’s not totally necessary to wait 30 minutes for the medications to work properly, it is ideal. If you choose to dose with food, there will be reduced absorption.