Our expert, Dr. Bryan Vartabedian, is a pediatric gastroenterologist and assistant professor of pediatrics at Baylor College of Medicine/Texas Children's Hospital in Houston, TX. He is the author of Colic Solved. Each month, he will answer selected reader questions about GERD and infants, children, teens and their parents. If you want to submit a question, write a SharePost here.
Q: Six months ago, my 8-year-old daughter started having a frequent sour taste in her mouth and occasional chest pain. Her doctor put her on Prevacid. She is four weeks into treatment and has no symptoms now. How long will she need to keep taking the medicine?
A: This is a great question because there isn't a one-size-fits-all answer. In fact, the duration of acid reflux therapy in kids is debated even among doctors. With that said, there are some basic considerations that may help you understand when it's appropriate to stop treatment.
The duration of acid suppression therapy (Prevacid, Nexium, Zantac, Axid) in a child will depend on how sick they are. School-aged children with chronic acid reflux disease may require therapy for months or even years. Children with a relatively recent onset of symptoms related to a virus or stressful life situation, for example, may need treatment only for a few weeks. A pediatric gastroenterologist or a pediatrician experienced in the management of GERD should be able to make that determination.
It is possible that a child's symptoms are acute and responsive to only a limited trial of therapy. But, sometimes a child's acid reflux began long before they experienced any symptoms. Sometimes the inflammation and injury that arise from acid reflux takes time to cause pain. A detailed history by an experienced doctor will uncover subtle signs that parents may often overlook.
Generally, physicians may recommend a limited trial of acid suppression medication such as Prevacid in a case like this. If the child responds well to the medicine, they may only take the medication for 3 to 4 months. After that, the child will stop and both the parents and the doctor will see how he does. Time will tell whether the symptoms are mild and short-lived or more involved and chronic.
There are some pediatric gastroenterologists in this case who would recommend endoscopy prior to the start of therapy. Some feel that there's a small possibility of significant damage to the esophagus in a child like this. The argument goes that this should be known before masking the disease findings and covering the evidence for a significant problem.
But as they say, "the devil's in the details" and there may be more to this case that's revealed in the history and physical. Get the input of a doctor experienced in the treatment of pediatric GERD. It sounds as though you're off to a good start with a doctor who is able to recognize the basic signs of acid reflux and, most importantly, isn't afraid to treat.