How to Wean Your Baby Off Reflux Medication

If you want to wean your baby off reflux medication, this should always be done under the supervision of their prescribing doctor.

This blog is a really important one because there is a lot of conflicting advice out there about how to wean off reflux medications and when this should be done.

In truth, if your baby is on a prescription medication to help their reflux or silent reflux, then they should be having regular reviews with the prescribing doctor or paediatrician, about every 4-6 weeks or so.

In this blog we discuss:

• What the main medications are for babies with reflux
• How PPI Medications Work
• Weaning off Medications - The Acid Battle
• When is Baby Ready to Wean off PPI Medications

To wean your baby off their reflux medications they must be ready to wean off them. And you need to understand how these medications work in the first place.

All too often I see parents starting to wean from medications for things to get even worse than ever and they think this means their baby still needs the medications, however, quite the opposite could be the truth.

To understand why this crops up with weaning, we first need to understand how the medications work.

How Do Reflux Medications Work?

The blog focusses on the PPI class of medications as the H2RA class are not being prescribed widely at this time. This includes medications with the active ingredient names lie omeprazole, esomeprazole, pantoprazole, lansoprazole and any others that end in "-prazole".

The medications block these little cells in the stomach, called the Proton Pumps. These cells are the ones responsible for producing the acid component for stomach juices. The dose of the medications will depend on what proportion of these cells get blocked or "inhibited". However, the mere act of blocking the cells does not stop the body from wanting to produce stomach acid to digest food, this is what it is supposed to do.

When we eat, our stomach produces a neurotransmitter called Histamine-2, which acts as a signal to get the stomach to produce stomach acid. When the stomach cannot produce enough acid to digest the food, it increased the amount of histamine produced in an attempt to get more stomach acid in there. 

Eventually the body will reach its highest possible level of histamine production, and this is usually where the "dose" of medications appear to work, or at least baby's body is not longer able to produce stomach acid so any regurgitation that is happening is not damaging their oesophagus.

Weaning off Medications - The Acid Battle

One of the few true occurrences of our bodies actually over producing stomach acid is when gastric acid suppression (GAS) medication (which is the most common type of medication your little one is on if they have prescription medication for their reflux) is being reduced.

What this means is that as you reduce the dose of GAS meds, your little ones body will truly be in a state where they are over producing stomach acid.

Why?

Because the increased levels of histamine-2 become "learned" by your baby's body, they become a "status quo", a set level, so that every time your baby's stomach receives food, it naturally produces this high level of histamine-2 as it knows that this is what it needs to do to get stomach acid produced.

However, when the medications are removed, the high levels of histamine remain, encouraging the stomach to produce high levels of stomach acid. With the proton pumps now actually able to produce stomach acid again, this leaves them responding to the forced high levels of histamine and so they produce far too much stomach acid than what is actually needed to digest the food in the stomach.

Over time, the stomach will relearn the new level of histamine needed to produce the stomach acid needed for the food consumed. However, there is a time lag between the medications being removed and the stomach returning to its natural state of acid production. And the longer a person is taking these medications, the longer it is for their body to find its 'normal'. This is the acid battle.

This means that far too often our babies appear to have reflux driven from the medication wean, when in truth, it is the natural process that their body has to go through to find it's new normal.

And too often this is interpreted as a sign that baby still needs the medications, rather than their bodies been given the time to adjust.

And yet this adjustment period could cause more oesophageal damage by once again, exposing the oesophagus to stomach acid that is not supposed to be there.

So we are stuck between a rock and a hard place...

Or are we?

When is Baby Ready to Wean off PPI Medications?

The truth is that GAS medications do not, and never have, addressed the underlying cause of reflux, because babies do not over produce stomach acid naturally (they do when they are teething and as outlined above).

So what are we to do? We know we don't want our children on these medications long term, and yet no one has a plan to get them off them. Or any of the attempts to wean have made this so much worse than before and you cannot possibly put your child through that distress to get them off medications, especially as the distress could last weeks, and cause more harm to their bodies.

When the underlying cause of your baby's reflux has been addressed, then you should be able to wean off their medications very easily without causing more damage.

How to Wean Baby from Reflux Medications

This is the most confusing part for most parents that I speak to. They have already spoken with their doctor, multiple doctors in many cases, and have been given a variety of information and suggestions, none of which have worked for their baby. The variety of methods that have been suggested to my clients (and these are NOT recommendations) include:

• Cold turkey - just stop the medications
• Move to administering medications every other day
• Half the dose every 3 days
• And many other variations on any of these or combinations of them 

Few of these approaches work and let me explain why:

1. Cold turkey - just stop the medications

If baby is still experiencing regurgitation, suddenly stopping the medications is unlikely to change the situation, in fact, with the sudden spike in acidity of the stomach acid now being produced, any reflux spit-up that happens is more likely to be highly acidic and cause irritation, discomfort and perhaps pain in the oesophagus. This could lead to baby crying more than they previously were doing, because their throat hurts, and this increase in crying can cause more air intake, causing reflux to get worse again. And so begins another reflux cycle.

2. Administer medications every other day

In this scenario baby's body can become more confused. One day, it's being forced to produce high levels of histamine (with the PPI medication) and the next day there is no medication and residual high levels of histamine so it thinks it needs to reduce histamine the next day, until it gets another blast of the PPI which encourages high levels histamine again. I have not yet observed this yo-yo approach to weaning off medications to work successfully and easily for any baby.

3. Half the dose every 3 days

This might sound like a good approach to a gradual reduction in reflux medications, and it is, however, it should come with the caveats that every baby's body will take a different length of time to adjust to a new level of histamine production in response to the reduced medication level. However, if their reflux has not been addressed at the root cause, then they could end up in the same place as a baby on the cold-turkey approach.

When Can You Stop Your Baby's Reflux Medications?

Your baby is ready to come off their medications when they are no longer having any regurgitation issues or regular spit up.

If your baby is experiencing reflux, then they are having stomach acid coming into their oesophagus. And this could be before or during a medication wean.

This is not caused by an over production of stomach acid, nor a weak lower oesophageal valve. There is a different cause. When we find that cause and address it, we stop baby's body from regurgitating anything.

Your baby should be able to keep milk, water and food in their stomach.  If they cannot, they still have reflux. There is a reason for it. If this is not addressed, then when you try to wean from medications then their body will regurgitate stomach acid into their oesophagus.

However, when the cause for their reflux has been addressed and they no longer experience any episodes of regurgitation, you should be able to reduce their medications as advised by the doctor much more easily. When you wean from the medications, their stomach will over produce acid, however, it should be able to contain it within their tummy, without regurgitating it and so avoiding damaging the oesophagus completely.

Yes they will likely experience some discomfort with bottom irritation from excess stomach acid passing through their gut, however there are other coping strategies we can use to minimise this, and the digestive tract can neutralise most acid, and is designed to be able to cope with small excesses of stomach acid... it's the natural progress of food through the body.

The Reflux Free Baby Workshop now contains a class where we talk about how to wean your baby off their medications in more detail. We must always do this in conjunction with the prescribing doctor, AND ideally your baby is no longer suffering with regurgitation as we have worked to resolve the root cause.... this is all done with you in the workshop.

Still Looking For the Cause of Your Baby's Reflux?

The answer lies in understanding what is causing your baby's reflux, and addressing this first. Then, when you are confident that they do not suffer from regurgitation at all, get in touch with their doctor and plan the wean off the medication.

If you want to understand what is causing your baby's reflux and how to resolve it so that you can get them off their medications too, the Reflux Free Baby workshop is the starting place. If they have gotten worse with solids, you may also need the Weaning Course that addressed how and why foods make reflux worse for 54% of babies and how to change things so that they are free from their reflux.

If you feel like you are not getting the support you need from your doctor, I can support you. I can help you to plan a "medication wean" to discuss with your doctor and ascertain if it's appropriate for your baby. Given the nature and uniqueness of how every child responds to medications, foods, reflux, weaning etc, I can only provide this support in a 1:1 situation.

Head to the links below for similar suggested blog titles:

• Does Gaviscon Infant Work for Reflux and Silent Reflux in Babies
• What To Do If Your GP Stops Your Baby's Reflux Prescription Milk?
• Gastro Oesophageal Reflux in Babies