Cimetidine

Neonates: 5 to 10 mg per kg per day, divided every 8 to 12 hours

Infants: 10 to 20 mg per kg per day, divided every 6 to 12 hours

≤ 12 years: 20 to 40 mg per kg per day, divided every 6 hours

> 12 years: 400 mg every 6 hours or 800 mg every 12 hours

Oral solution

Affects cytochrome P450, vitamin D metabolism, endocrine function

Improves symptom scores, reflux index, and histologic and endoscopic findings in infants and children

$40 for one 270-mL bottle

(300 mg per 5 mL)

Famotidine (Pepcid)

0 to 3 months: 0.5 mg per kg per day

3 to 12 months: 0.5 mg per kg twice daily

1 to 16 years: 0.5 mg per kg twice daily

Oral suspension

Lacks evidence showing effectiveness in infants and children

Approved for up to 8 weeks of use in infants and up to 6 weeks of use in adolescents

$75 ($180) for one 50-mL bottle (40 mg per 5 mL)

Nizatidine (Axid)

6 months to 11 years: 5 to 10 mg per kg per day, divided every 12 hours

≥ 12 years: 150 mg twice daily

Oral solution

Improves symptom scores in infants; improves reflux index and histologic and endoscopic findings in infants and children

$40 ($55) for one 60-mL bottle (15 mg per mL)

Ranitidine

Infant to 16 years: 5 to 10 mg per kg per day, divided every 12 hours; maximum dosage of 300 mg per day

> 16 years: 150 mg twice per day

Syrup

Most commonly used H₂ receptor antagonist

No evidence for symptomatic improvement in infants, but has shown symptomatic benefit in children

Improves reflux index and histologic and endoscopic findings in infants and children

$30 for one 60-mL bottle (15 mg per mL)

Esomeprazole (Nexium)

1 to 11 years: 10 mg per day

≥ 12 years: 20 mg per day (alternative dosage for infants, children, and adolescents: 0.7 to 3.3 mg per kg per day)

Sprinkle contents of capsule onto food

Approved for up to 8 weeks of treatment

Improves reflux index in infants; no evidence of improvement in symptom scores

Improves symptom scores and histologic and endoscopic findings in children

$200 ($260) for 30 capsules (20 mg)

Lansoprazole (Prevacid)

3 to 12 months: 7.5 mg twice daily or 15 mg per day

1 to 11 years:

≤ 30 kg: 15 mg per day

> 30 kg: 30 mg per day

≥ 12 years: 30 mg per day

Sprinkle contents of capsule onto food or into juice; disintegrating tablet

Improves symptom scores, reflux index, and histologic and endoscopic findings in children

No evidence of effectiveness in infants

Approved for 12 weeks of use in children and 8 weeks of use in adolescents

Well tolerated in children

$40 ($350) for 30 capsules (15 mg)

$130 ($350) for 30 tablets (15 mg)

Omeprazole (Prilosec)

Infants: 0.7 mg per kg per day

> 1 year and adolescents:

5 to < 10 kg: 5 mg per day

10 to < 20 kg: 10 mg per day

≥ 20 kg: 20 mg per day

Sprinkle contents of capsule onto food

Improves symptom scores and reflux index in infants and children

Risk of respiratory infections in critically ill children

$20 ($210) for 30 capsules (10 mg)

Rabeprazole (Aciphex)

1 to 11 years:

< 15 kg: 5 mg per day

≥ 15 kg: 10 mg per day

≥ 12 years: 20 mg per day

Tablet

Lacks evidence of effectiveness in infants and children

Approved for up to 12 weeks of use in children 1 to 11 years of age

Approved for up to 8 weeks of use in children 12 years and older, and in adolescents

$40 ($440) for 30 tablets (20 mg)

Bethanechol

Children: 0.1 to 0.2 mg per kg per day, divided every 6 to 8 hours; 1 hour before meals

Tablet

Lacks evidence showing effectiveness in infants and children

May induce respiratory bronchospasm

$20 for 30 tablets (5 mg)

Erythromycin (E.E.S.)

1.5 to 12.5 mg per kg every 6 to 8 hours

Oral suspension

Lacks evidence showing effectiveness in infants and children

No specific dosing recommendations for GERD

Associated with hypertrophic pyloric stenosis in infants younger than 6 weeks

NA ($325) for one 100-mL bottle (200 mg per mL)

Metoclopramide

0.1 to 0.2 mg per kg three to four times per day

Oral solution

Not recommended for routine treatment of GERD

34% of treated patients have adverse effects (drowsiness, restlessness, rare extrapyramidal symptoms); use is generally not recommended

$4 for one 60-mL bottle (5 mg per 5 mL)

Antacids (magnesium or aluminum hydroxide)

Not recommended < 12 years; dosing varies depending on antacid

Tablet

FDA approved for infants (magnesium hydroxide only), children, and adolescents

May produce milk alkali syndrome; caution in renal disease

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Sucralfate (Carafate)

Dosing not well established; in children, 40 to 80 mg per kg per day divided every 6 hours has been used

Tablet; oral suspension

Constipation, dizziness, light-headedness

$15 ($80) for 30 tablets (1 g)

NA ($45) for one 120-mL bottle (1 g per 10 mL)