When to Wean Your Child From PPIsby Jennifer Mitchell Wilson B.S. Dietetics, Dietitian, Health Professional
In my career working with the Pediatric Adolescent Gastroesophageal Reflux Association (PAGER) I have found that there are several questions that come up over and over. One of these such questions is regarding how to wean your child from acid reflux medications.
The first step in weaning your child from acid reflux medications is to make sure that they are no longer in pain. If they are still having frequent painful reflux episodes on medication then weaning them off will at best make the symptoms worse and at worst it could cause esophagitis or other damage. Pain is a sign that the medication is still needed.
The second step in weaning is to be sure that you pull EVERY reflux trigger from your child's diet. Even if they could eat the food on medication it does not mean they will be able to eat it when you pull the medications. Most of the main triggers are spicy foods, high fat meals, citrus juice and fruits, tomato and tomato based products, soda and chocolate. It may be a pain to pull these foods but don't worry You can gradually add them back AFTER your child is used to being off of the medicines.
The third step is to give your child the best gut health you can before weaning. That means making sure your child gets at least 15-20g of fiber and plenty of water. It also helps to add a probiotic to balance gut bacteria. Biffidus, Acidophilus and Lactobacillus are the three most studied for gut health. You can find them in some yogurts and keifer or you may use a supplement.
The last step is the actual weaning of medications. With our daughter we went in two week increments. We chose two week increments because PPI medications reach their full effect with in two weeks.
We decided it would be best to wait at least that long to wean even lower.
For the first two weeks we cut the dosage in half. If your child is on a very high dose you may choose to cut the dose by only 1/3. Once it was clear that the pain and reflux had not returned we started to give the 1/2 dose every other day (or you could give 1/4 of the original dose. If you get that far and your child does not have pain then you can completely eliminate the medication. Wait the next two weeks and pay close attention to any return of symptoms.
Lets say you cut your child's dose to 1/2 of the original and they do well. Then you try to cut it to 1/4 and symptoms return. Instead of going back to the full dose try going back to 1/2 dose. If that resolves the issue then you can remain at that dose. It may be frustrating that you can get your child off the meds in that situation but at least you were able to reduce the amount.
Weaning does not always work the first time. Be patient. If it doesn't work at all then wait 3-6 months and try again. Be sure to talk to your doctor before trying to wean because they may have additional information or reasons why you should not embark on this quest. Good luck!!