Symptom Based Treatment of Infant Acid Reflux
Here we explain the Marci Kids Study and why it works for babies with more severe symptoms that aren't getting relief from more mild beginning stage treatments.
Jeffrey Phillips Pharm D., the lead in the 12 year study explains it in the video above.
The “Marci Kids Study" was a three center study (done at the University of Missouri and two other centers) performed by a group of physicians, nurses and pharmacists that specialized in infant GERD, which successfully treated thousands of babies.
The basis of the study was, that because infants and small children metabolize many medicines (including PPI medicines) much faster than adults, infants and small children required higher doses, more frequently to control acid reflux disease symptoms.
UpToDate is a subscription resource exclusive to medical care practitioners that are interested in the most recent and verifiable treatment studies and science based medicine.
Up to date is publishes the most recent findings in the medical industry. This article on PPI dosing in infants 8-2019
The graph above, created during the Marci Kids Study, shows the half-life (50% of the initial dose is used up by the body) of lansoprazole in infants and children. As you can see there is a relationship between age and half-life with some degree of variability. This is important to consider because half-life effects how well and how long acid is controlled in the baby's body.
Tran A, Rey E, Pons G, Pariente-Khayat A, d'Athis P, Sallerin V, Dupont C. Pharmacokinetic-pharmacodynamic study of oral lansoprazole in children. Clinical Pharmacology and Therapeutics. 2002;71: 359-367.
Some infants (not all) required a higher dose to control acid reflux symptoms so there may be times when an increase in the milligram (mg) per milliliter (mL) concentration and/or the dose is the only way to control the acid production for that baby. All babies are different and all metabolisms are different. Which is why finding the right doctor is key to getting an effective treatment plan for your baby specifically.
We do offer care to those looking for help in our online telemedicine appointments. You'll have the benefit of working with a medical professional that can provide you with the specialty treatment your baby needs.
Common Questions About PPIs & The Marci Kids Study
A common question is: Can I give too much to my baby? The short answer is NO!
PPIs are very specific in where they work in the body and are only active in a very specific place, the acid secreting portion of a cell, called the parietal cell. Since PPI drugs only work on the acid secreting cell they have generally a good safety profile. PPI drugs are known as pro-drugs because they are not active in the bloodstream. PPIs only become active when they pass into the acid secreting portion of the parietal cell (the cells in the stomach that make acid). This is important because we get this question a lot. Whatever the body does not put to use gets passed through the system.
Another common question is: Are PPIs safe? Again, the short answer is YES!
PPIs are known to be some of the safest drugs on the market. ESPECIALLY for the short time frame that is typically needed to treat infant GERD and because of how they work in the specific area of acid production. This coupled with the fact that PPIs are pro-drugs and how they are processed in the body make them very safe.
There have been MANY MANY studies showing how safe PPIs are and here are a couple of links for you to refer to. Yes, we know nobody wants to give their baby medication but if they are sick and they need it, in some cases the path to a healthy happy baby is safe, effective and temporary.
If fact you can find those articles posted on our site and are from external resources (meaning, they come from sources that are external from this practice and from very reliable medical scientists and doctors that are not associated with our practice.
- PPI Contraindications - What not to do when using a PPI. Specifically H2 blockers.
- Low Dosing PPIs - The dose you're giving may be making things worse. Here's why.
- PPI Side Effects - Ranked some of the safest drugs on the market.
*MBCHB, FRCPC, FACG. Decisions in diagnosing and managing chronic gastroesophageal reflux disease in children. Journal of Pediatrics 2005; 146:3-12
Burnett JE, Balkin ER. Stability and viscosity of a flavored omeprazole oral suspension for pediatric use.
American Journal of Health-Systems Pharmacy 2006; 63:2240-2247.
Clinical studies showing that higher PPI doses are required to achieve healing in pediatric patients are listed here on the PPI dosing information page below. Along with them are the credits for those who participated and published these studies:
Gunasekaran TS, Efficacy and safety of omeprazole for severe gastroesophageal reflux in children. The Journal of Pediatrics 1993; 123:148-154.
Israel D, Shepherd R, et al. Omeprazole for treatment of chronic erosive esophagitis in children: a multi-center study of efficacy, safety, tolerability and dose requirements. The Journal of Pediatrics 2000; 137:800-807.
Iarocci TP, Tan H, Singer, J, Barron J, Pilzer E, Patel D, Bakst A. Proton pump inhibitors in infants. [Abstract] American Journal of Gastroenterology. 2005; 100(suppl.):S273.
Clinical study of pharmacokinetics of omeprazole in children
Andersson T, Lundborg P, et al. Pharmacokinetics of orally administered omeprazole in children. American Journal of Gastroenterology 2000; 95:3101-3106.
Pharmacokinetic study showing the relationship between lower age and higher dosing requirements in pediatric patients: younger children require higher and/or more frequent doses due to shorter PPI half-life. The first author is employed at Astra (company that makes Prilosec.)
Reviews of PPI use in children: pharmacokinetics, safety, efficacy, and PPI dosing information
Israel DM, Omeprazole and other proton pump inhibitors: pharmacology, efficacy, safety, with special reference to use in children. Journal of Pediatric Gastroenterology and Nutrition. 1998; 27:568-579.
Specifically states that on a per kilogram (weight) basis, children require higher doses of omeprazole than adults due to different pharmacokinetics of omeprazole in children. Discusses at length the use of buffered PPI suspensions in children as a preferred dosage form.
Litalien C, Theoret Y, Faure C. Pharmacokinetics of proton pump inhibitors in children. Clinical Pharmacokinetics 2005; 44:441-466.
Abstracts by Jeffrey Phillips, Pharm.D., describing use of ChocoBase and CaraCream in pediatric patients; includes some PPI dosing information
Phillips JO, Bettag ME, Parsons DS, Wilder B, Metzler MH. Use of flavored lansoprazole or omeprazole suspensions in pediatric GERD. [Abstract A1292] Gastroenterology 2000; 118: 5904.
Phillips JO, Parsons DS, Fitts SW. Flavored lansoprazole suspension in pediatric GERD. [Abstract] Journal of Pediatric Gastroenterology and Nutrition 2000; 31:S181. [Abstract No. 707].
This PPI dosing information and chart and a portion of the textual contents of the PPI dosing information page came from the Marci-kids website.