Your baby spits up constantly. They cry during feeds. You’re exhausted, and someone’s suggested medication. Before your baby starts proton pump inhibitors (PPIs), know this: acid reflux in newborns often responds to simple changes. As a paediatrician in Johannesburg, I see parents reach for medication too quickly when other options haven’t been tried. Let me walk you through what actually works.
Understanding Reflux in Babies
Here’s the tricky part: reflux looks like what it is, spit-up and crying. But so do hunger, allergies, and a dozen other things. Gastroesophageal reflux (GER) is common and usually harmless. Gastroesophageal reflux disease (GERD) is more serious, causing real pain and feeding problems.
The challenge? Both present in the same way, which means diagnosis matters before treatment.
What to Try First
Change feeding patterns
Many babies improve with smaller, more frequent feeds. Instead of one 120ml bottle every three hours, offer 80ml every two hours. Less volume in the stomach means less comes back up.
If breastfeeding
Thickeners exist for expressed milk, but they’re messy, and the mixture can turn gelatinous or your baby may refuse it. Instead, investigate whether your baby reacts to cow’s milk protein in your diet. Many reflux babies improve when mothers eliminate dairy. Give it four weeks to work.
Thicken the feeds
This works surprisingly well. Adding starch thickens the formula and reduces regurgitation. For formula-fed babies, switch to thickened formulas like Novalac AR or NAN AR. The starch binds the milk, keeping more of it down.
Consider formula options
If cow’s milk seems problematic, try an extensively hydrolysed formula (proteins broken down into tiny units). If that fails, an amino acid-based formula removes the allergen entirely.
These approaches work for many families. I’ve seen parents skip medication completely once they make these changes.
When PPIs Enter the Picture
Proton pump inhibitors reduce stomach acid by blocking the enzyme that produces it. Nexium and Prilosec are common brands. They work, but they’re not first-line treatment.
If simple measures fail and your child has confirmed GERD (not just reflux), PPIs may help. Here’s what matters:
Dosing principles
- Use the lowest effective dose
- Treat for the shortest possible time
- Only start with confirmed GERD, not suspected reflux
The stopping problem
Never stop PPIs abruptly. Your baby’s stomach will overproduce acid (rebound hyperacidity), bringing symptoms roaring back. Taper slowly under your doctor’s guidance.
Side effect concerns
PPIs are generally safe in children. However, adult studies show risks of vitamin B12 deficiency, low magnesium, and bone fractures. Whether these apply to babies remains unclear; we need more research. Some evidence suggests increased infection risk, but it’s not conclusive.
The Real Question
Should your baby take medication? Maybe. But not before you’ve tried the basics. I treated my own son’s reflux many years ago when he was a baby, and people thought I was mad to suggest medication. Today, reflux is better understood, and so are the non-pharmaceutical options.
The goal is identifying true GERD, treating conservatively first, and using PPIs only when nothing else works.
Your baby’s reflux needs proper assessment. Book a consultation at my Johannesburg practice. I’ll help you distinguish between normal spit-up and true reflux, and we’ll develop a treatment plan that doesn’t jump straight to medication.
