Medicines advice

Concerns raised about overuse of ‘PPIs’ in babies

Research published over the summer raised concerns that some babies may be receiving unnecessary treatment for regurgitation (reflux) using a type of medicine called proton pump inhibitors, shortened to PPIs. These include omeprazole, esomeprazole and lansoprazole. This Medicines for Children news item explains what PPIs are and whether they are helpful in babies.

October 1, 2024

What is regurgitation/reflux?

Young babies often bring up milk after a feed – this is called regurgitation or reflux. It happens because the muscle valve at the top of the stomach is weak in babies, allowing milk to come back up.  Large feeds can also put pressure on the valve.

Babies may be fussy following feeds. This fussiness and regurgitation can be difficult for parents to manage and they may worry and seek help from a doctor. However, in most babies regurgitation is normal and is not caused by a clinical problem. As babies develop, they regurgitate less as they spend more time upright.

What are PPIs?

PPIs are medicines that block the release of acid in the stomach. They are used in adults to treat gastroesophageal reflux disease (GORD). This is where the acidic stomach contents come up through the valve into the oesophagus (the tube from the mouth to the stomach), causing a burning feeling. PPIs make the stomach contents less acidic so there is less pain.  GORD may sound similar to regurgitation in babies. However, the stomach contents in babies are much less acidic than in adults and are unlikely to cause harm or pain.

Do PPIs help babies with regurgitation/reflux?

Clinical studies have found that treatment with PPIs is usually not helpful in most babies. PPIs do not stop them from regurgitating milk or help with general fussiness. Often, regurgitation improves in babies as they get older, not because of treatment.

A small number of babies may have severe reflux or GORD. This may affect their ability to feed and they may not grow properly. PPIs may be helpful for these babies.

Can PPIs cause harm?

There is a risk of side-effects (unwanted effects) with any medicine. PPIs can sometimes increase the risk of infections and allergies in babies. They may also reduce the absorption of some nutrients from milk.

What should I do if my baby has been prescribed PPIs?

The article raised concerns that PPIs are being prescribed for babies with normal reflux, even though they are unlikely to be helpful. If you baby has mild reflux and is healthy and growing well, PPIs are not generally helpful and may cause harm. If your baby has been prescribed PPIs, you may want to discuss the risk and benefits of continued treatment with your doctor. However, do not stop giving any medicine without discussing with your doctor first.

Where can I get more information?

You can ask your pharmacist, midwife or health visitor for more information. The charity Living with Reflux and the National Childbirth Trust (NCT) also produce useful advice about reflux on their websites.