The Truth About Infant Reflux Medications

There are several different types of interventions and medications used to manage infant reflux. Each has its own mechanism, potential benefits, and limitations. It’s important to understand how each one works so you can make informed decisions and ask the right questions when speaking with your healthcare provider.

1. Feed thickeners or thickened formula

These products are added to breastmilk or formula to make feeds heavier and more difficult to regurgitate. They are not medications themselves, but they're often the first intervention suggested for reflux.

What they do: Thickeners reduce the likelihood of visible vomiting or posseting by increasing the density of the milk in the stomach.

What they don’t do: They do not address the cause of the reflux. They simply change the physical properties of the feed, making it harder for the body to regurgitate milk.

Side effects to watch for: Thickeners (often made from rice, corn, or potato starch, or maltodextrin) can cause trapped wind, bloating, or constipation. Some may also be allergenic for certain babies.

2. Alginate therapy (e.g. Gaviscon)

Alginates form a "raft" or gel-like layer on top of the stomach contents. This physical barrier is designed to prevent stomach acid and food from refluxing into the oesophagus.

What they do: They can reduce episodes of regurgitation and protect the oesophageal lining from contact with acid.

What they don’t do: They do not resolve the underlying cause of reflux or regurgitation.

Common side effect: Constipation is frequently reported, yet not formally listed in patient leaflets. In a recent Instagram poll of over 100 parents, 72% said their baby experienced constipation with Gaviscon.

Important safety note: Ensure your baby is given the infant formulation. Adult formulations may contain aluminium, which is associated with impaired phosphate absorption and bone development issues later in life [reference].

3. H2 Receptor Antagonists (H2RAs) — e.g. ranitidine, famotidine

H2RAs work by blocking histamine-2 receptors in the stomach lining, reducing the amount and acidity of stomach acid produced.

What they do: These drugs reduce the burning sensation caused by acid reflux and may ease discomfort in the oesophagus.

What they don’t do: They do not stop regurgitation or address the root cause of reflux.

Mechanism and side effects: These medications delay gastric emptying and increase stomach contractions—two factors that can worsen reflux in some babies. They also increase histamine levels in the bloodstream, which over time may contribute to histamine intolerance or sensitivity [reference].

Safety alert: Ranitidine was withdrawn in many countries due to concerns over NDMA contamination (a probable carcinogen). Famotidine is now more commonly used, though its safety and efficacy have not been established in children under 12 years [reference].

4. Proton Pump Inhibitors (PPIs) — e.g. omeprazole, lansoprazole

PPIs suppress acid production more aggressively by inhibiting the proton pumps in stomach cells responsible for acid secretion.

What they do: They reduce the acidity of stomach contents, easing symptoms of oesophageal inflammation or burning.

What they don’t do: They do not stop the reflux (regurgitation). And during the "ramp-up" phase, symptoms may initially worsen — a phenomenon known as the "acid battle".

Side effects (proven in infants):

• Increased risk of gastroenteritis [reference]
• Higher rates of pneumonia and respiratory tract infections [reference]
• Increased risk of necrotising enterocolitis in preterm babies [reference]
• Small intestine bacterial overgrowth (SIBO) and increased flatulence [reference]
• Higher risk of bone fractures in later childhood [reference]

Important: Only one PPI (omeprazole suspension) is approved for infants over 1 month old. Others are often prescribed "off-label" and have not been tested or licensed for babies under 12 months of age.

5. Antihistamines — e.g. Ketotifen, cetirizine, piriton

These are typically used to manage allergy symptoms. In babies with reflux, they’re sometimes used when a histamine-related intolerance is suspected.

What they do: May temporarily reduce inflammation or allergy-driven symptoms.

What they don’t do: They do not address the reflux mechanism itself.

Side effects: Common side effects include drowsiness, irritability, insomnia, and in some cases increased fussiness or digestive upset.

6. Domperidone

This is a motility agent used to speed up gastric emptying. It was previously prescribed for infants but has since been restricted or withdrawn in many regions due to potential cardiac side effects [EMA safety review].

Important: In most cases, domperidone is no longer considered appropriate for infants unless under strict specialist supervision.

In my practice however, I still see babies frequently prescribed Domperidone, and without the appropriate screenings to ensure this is the correct medication to use.

These medications may provide short-term relief or protection from acid-related damage. They are valuable tools in specific circumstances, particularly when pain or inflammation needs to be managed. However, they do not resolve the underlying cause of your baby’s reflux. That’s where a root-cause approach becomes essential.

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All medications carry the potential for side effects. It's important to understand both the expected effects and the potential unintended consequences, especially when it comes to babies whose bodies and systems are still developing. Below is a breakdown of common reflux treatments and the known side effects associated with each.

1. Feed Thickeners & Thickened Milks

3. H2 Receptor Antagonists (H2RAs – e.g. Ranitidine)

Side effects listed as “uncommon” include abdominal discomfort, constipation, vomiting, and nausea—many of the same symptoms we're trying to alleviate. These medications may also increase the body’s production of histamine over time, leading to histamine intolerance and worsening food reactions later on. This is based on clinical observations and patterns reported by families, and is being increasingly documented.

4. Proton Pump Inhibitors (PPIs – e.g. Omeprazole, Lansoprazole)

PPIs are associated with a wide range of side effects, including:

• Common or very common: abdominal pain, diarrhoea, headache, skin rashes, dry mouth, and insomnia
• Serious adverse effects in babies:
• Increased risk of gastroenteritis and respiratory infections
• Small intestine bacterial overgrowth (SIBO)
• Higher risk of candidemia in NICU babies
• Increased bone fracture risk in childhood

While designed to reduce stomach acid, PPIs also alter digestion and gut flora in ways that may cause long-term imbalance. They are usually not licensed for babies under 12 months except in specialist preparations, so parents must weigh this carefully.

5. Antihistamines (e.g. Ketotifen, Ceterizine, Piraton)

Prescribed for suspected allergies or inflammation, these medications can cause side effects like irritability, insomnia, and anxiety. Many parents notice these behavioural changes in the early stages of use.

6. Erythromycin

Although primarily an antibiotic, erythromycin is sometimes used off-label to encourage gastric motility. However, its use in infants is controversial. Known side effects include:

• Gastrointestinal distress – stomach cramping, diarrhoea, and vomiting
• Potential pyloric stenosis risk in newborns (especially under 6 weeks) [source]

This is rarely explained during prescription, so it’s important parents understand that this is not a “mild” option—it’s a potent medication with risks that must be weighed.

In Summary: While some medications may offer temporary relief, none address the root cause of your baby’s reflux. They come with side effects that can impact gut health, immune response, and emotional well-being. These are not decisions to make lightly, which is why knowing all this information matters.

And remember: you are allowed to ask these questions. You are your baby’s best advocate.

If you’d prefer a guided path to understand the root cause and fix it—without long-term reliance on medication—the Reflux-Free Framework is here to support you.

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It’s one of the most important questions you can ask and one that deserves a clear, honest answer.

We assume that anything prescribed for a baby has been tested and approved. We assume it’s “safe.” But what does that really mean?

Safety is not a fixed definition—it depends on your values, your child’s needs, and your understanding of risk. For some, safe means “not fatal.” For others, it means “won’t cause side effects,” or “won’t affect my baby long-term.”

This is why you’re allowed to ask questions. You deserve to understand what’s going into your baby’s body, and what the implications might be—immediate or later on.

What the guidelines say

Most reflux medications aren’t fully approved for babies under 12 months. In many cases, they’re prescribed “off-label”, meaning the manufacturer hasn’t tested or licensed them for use in infants.

That doesn’t automatically mean they’re harmful, but it does mean the safety profile is incomplete. And when doctors prescribe these medications for babies, they take responsibility for the outcomes.

Let’s break it down:

1. Alginate Therapy (e.g. Gaviscon)

Infant versions are specifically designed for babies, but adult formulations contain aluminium—a compound linked to phosphate depletion and bone disease when used long-term [source]. There have been documented cases of infants mistakenly given adult versions, which is why clear instruction and labelling matter.

2. H2 Receptor Antagonists (e.g. Ranitidine, Famotidine)

Ranitidine was recalled globally due to contamination with a probable carcinogen, NDMA. It hasn’t returned to the market in most countries as of 2024.

Famotidine is now often used instead, especially in the U.S., though it’s not licensed for children under 12. Manufacturer guidance states: “Safety and efficacy in children has not been established.” That means these medications are being used without long-term infant safety data.

3. Proton Pump Inhibitors (PPIs – e.g. Omeprazole, Lansoprazole)

Only one specific formulation—Omeprazole suspension—is approved for infants over 1 month. However, other PPI variants are frequently prescribed. 

Many parents are not told that PPIs are not approved for under-1s in most cases. So when these medications are prescribed, it’s based on clinical discretion, not manufacturer recommendation.

Again, this doesn’t mean the medication is inherently unsafe, but it does mean you need to understand the limitations of the research and approval status.

So, is it safe?

It depends on your definition of safe. And your trust in the answers you’ve received.

You’re not wrong to question whether a medication that hasn’t been studied in babies, or is only licensed for adults, is right for your baby. You’re also not wrong to use it when the benefit outweighs the risk.

Medications can play a role in healing, however they aren’t the whole solution. When used long-term without addressing the root cause of reflux, they may simply delay healing, rather than support it.

If you’re not sure what your options are, or you want to find the true cause of your baby’s discomfort before relying on medication, the Reflux-Free Framework is where that journey begins.

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This is one of the most overlooked questions and yet, it's absolutely critical.

If you decide to give your baby medication for their reflux, one of the first things you’ll want to know is: how long should it take before we see an improvement?

When your baby is suffering, waiting even a few days feels like a lifetime. You deserve to know what results to expect and when. 

Unfortunately, many parents are told to "give it a few weeks," without clarity on what changes should happen—or what red flags to look for. Here’s what to expect, step by step:

In short: If your baby isn’t showing improvement after a few days on any reflux medication, it’s time to review the treatment plan with your doctor. These medications are not meant to be trialed endlessly, and a lack of improvement signals it’s time to look deeper.

IMPORTANT: If the medication isn’t working as expected, or if your baby gets worse, don’t assume the next step is a higher dose. Your baby wasn't born with a pharmaceutical deficiency.

Always listen to your gut and track what’s happening. Using a detailed tracker helps you see what’s really changing, when, and why.

Remember, none of these medications will ever directly address the underlying cause of your baby's reflux.

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This is one of the most important questions to ask — and one that too often goes unanswered.

When your baby is struggling and your doctor offers medication, it’s natural to assume it will help. After all, why would they prescribe something that won’t fix the problem?

Yet the truth is: reflux medications do not work for every baby. And they’re not designed to solve reflux, they’re designed to reduce acid or slow stomach emptying. They don’t treat the root cause of your baby’s discomfort.

I’ve been running an ongoing survey of parents since 2017. Here’s what we’ve found:

• 90% of babies diagnosed with reflux or CMPA are prescribed reflux medications.
• 76% of those babies continue to experience reflux symptoms despite being medicated.

So even though medications are widely prescribed, they often provide only partial or temporary relief and many babies remain in discomfort.

If the medications were consistently effective, we wouldn’t see such a high number of babies still struggling months (or even years) later. And we wouldn’t need to escalate through multiple medications, doses, or combinations just to “see what works.”

That’s why I always recommend using medication as a short-term support tool, not a long-term solution.

They can reduce pain, especially in cases where the oesophagus needs time to heal from acid damage. In those cases, medications may provide a vital window to investigate and address the root cause. But they must be reviewed regularly and used with an actual plan, not just hope.

If your baby has been on medication for a few weeks and is still struggling, it’s time to look deeper. Symptoms are messengers: they’re telling us something important.

The goal is not to simply mask symptoms. The goal is to resolve the cause, so your baby no longer needs medication at all.

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This is a question more parents should be asking at the beginning, yet many don’t, because we’re often led to believe that the medication is the only option and that it’s safe to take as long as needed.

Here’s the reality: we simply don’t know how long your baby will be on reflux medications. And that’s part of the problem.

In adults, taking gastric acid suppressants like PPIs (proton pump inhibitors) for more than three months is considered long-term use. The same medications are frequently prescribed to babies for much longer, often with increasing doses over time, and without clear guidelines or regular review.

In fact, some manufacturers of these medications explicitly state they should not be taken for extended periods unless under specific instruction. Many advise no more than 14 days of treatment in a four-month window, yet babies are often left on them for six months, a year, or longer.

According to my data, over 55% of babies remain on reflux medications past 12 months of age. And many families tell me that even after months of increasing doses, their baby is still uncomfortable, unsettled, or not gaining weight well.

When dosage keeps going up but symptoms persist, it’s a red flag, not a reason to push harder. It’s a signal that we need to look at the root cause of the reflux, not just mask the symptoms.

What’s more, continuing to use these medications without addressing the underlying issue can lead to dependency. There is even clinical recognition that higher doses often result in a longer need for treatment, not because the baby still needs it, but because the treatment itself alters stomach function.

This is where a personalised, root-cause approach can change everything.

When families I work with discover what’s actually behind their baby’s symptoms, we can often resolve the root issue, then safely and smoothly step off medications. For some, this means freedom after years. For others, it’s relief after weeks of ineffective treatment.

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For years, ranitidine (Zantac) was one of the most commonly prescribed medications for infant reflux. Then, between November 2019 and April 2020, it was pulled from shelves globally due to contamination with NDMA, a probable carcinogen. This wasn't a temporary shortage—it was a full recall.

Since then, ranitidine has remained unavailable in most Western countries. This has left a lot of parents wondering what to do if their baby was previously prescribed this drug, or if it's been suggested again now that alternatives are less clear.

Here’s what you need to know:

✅ If your baby was prescribed ranitidine before the recall and it helped, that doesn’t mean you did anything wrong. The contamination issue was linked to certain batches and how the drug was stored. You made the best decision you could at the time with the information you had.

❗If you’re being offered ranitidine now, double-check whether it is available legally and safely in your country. In most places, it still isn't on the market.

🔄 Doctors may now be turning to famotidine as an alternative. While it’s often seen as the “replacement,” it’s important to know that the manufacturers themselves state: “The safety and efficacy of famotidine in children has not been established.” This includes children under 12 years of age.

So where does this leave us?

It reinforces the need to get clear on why your baby is refluxing. If the cause is unresolved, the medication may be acting as a plaster, not a solution. And when that plaster disappears—whether through a recall or side effect—it can feel like you’re back to square one.

This is why I always return to this: medications can be helpful, but they should never be the end of the journey. They are a tool, not the solution. It’s the understanding of what’s driving your baby’s discomfort that brings the long-term results.

If you're currently questioning whether a medication is right for your baby, or you're unsure what to do after the ranitidine recall, you're not alone. I support families every week navigating this exact situation.

This is one of the most commonly overlooked aspects of reflux medication: regular review and reassessment.

The NICE guidelines (UK) and similar standards internationally recommend that reflux medications in infants should be reviewed every 4 weeks. This ensures the treatment is still necessary and effective, and it protects against long-term use when no longer needed.

In reality, many families report their baby is kept on medications for months—or even over a year—without any scheduled reviews, re-evaluations, or support for weaning. This isn't best practice, and it fails to consider whether the baby still needs the medication or if circumstances have changed.

A review should cover the following:

• Is the medication helping?
• Has anything changed in your baby’s feeding, behaviour, or sleep?
• Are there any new symptoms or side effects?
• Is the dosage still appropriate for your baby’s weight?
• Is it time to begin exploring weaning off the medication?

If your healthcare provider has not scheduled a review, it’s important that you initiate this conversation. You are your baby’s advocate, and regular review is your right.

Sometimes, medications continue simply because no one has considered stopping them. And the longer they’re used, the more potential risks are introduced. Additionally, and particularly with medications in the PPI class and ketotifen, the longer a baby is on them, the harder they are to wean off them and the longer their nutritional status is being compromised.

Regular review is a key step in ensuring your baby receives the most appropriate care—not just ongoing prescriptions by default.

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For many families I work with, weaning their baby off reflux medication is one of their biggest goals. Often, they weren’t comfortable starting medication in the first place—or they’re now unsure if it’s helping, and whether it might be doing more harm than good.

The trouble is, most parents are given little to no guidance about how to come off these medications safely and effectively.

Some are told to reduce the dose gradually over weeks or months. Others are told to alternate days. Some are even told to "just stop". These inconsistent messages lead to confusion, distress, and often, unnecessary prolonged use.

Worse still, when parents attempt to wean and see a return or flare of symptoms, they’re told the medication is still “needed”. In many cases, this rebound effect is not the return of reflux—it’s the body’s withdrawal response to the suppression of acid, often known as acid rebound.

This doesn’t mean the wean has failed. It means it needs to be done with the right strategy and support.

One recent client came to me after trying three different approaches over five months to wean her son off medication. Each time, his symptoms became worse. By the time we worked together, we discovered he had developed a histamine sensitivity as a result of prolonged medication use. This is one of many potential side effects that can complicate the weaning process.

Together, we took a targeted approach—addressing the underlying cause of his reflux, building his tolerance, and rebalancing his system step by step. In 21 days, he was medication-free and smiling again.

So, how do you safely wean your baby off reflux medication?

• First, understand what the medication is doing and why it was prescribed.
• Second, identify whether the original cause of reflux has been resolved. If not, you risk flaring symptoms again.
• Third, work with a plan—tailored to your baby’s body, not a standard dose or weaning chart.

This is exactly what I help parents do inside the Reflux-Free Framework. There’s also an option for two live group coaching calls where I personally guide you through your baby’s symptoms and create a plan.

You can get off the medications. You just need the right roadmap.

⬅ Back to Questions

You’re not alone in feeling this way.

It’s completely understandable to want to explore other options before medicating your baby. The truth is, many parents feel uneasy about starting medications, especially when the cause of reflux hasn’t been fully explained.

So what can you do instead?

Start by asking the most important question:

“What is causing my baby’s discomfort?”

Reflux is a symptom, not a diagnosis. It has many possible causes—digestive immaturity, food sensitivities, oral restrictions, feeding tension, gut inflammation, and more. The best way to move forward is to understand exactly what’s going on for your baby.

This is where the Reflux-Free Framework comes in. It’s the process I’ve developed to help you uncover the true cause of your baby’s reflux and finally take the right steps to resolve it—without endless guesswork or years of struggle.

Step one is using the Symptoms Tracker to observe your baby’s patterns and behaviours. From there, you can follow a clear roadmap inside the course that shows you how to connect those symptoms to their true cause—and then take targeted action that works.

Prefer my direct input?

There’s now an upgraded option where you can join two live group coaching calls with me. I’ll personally review your baby’s symptoms, guide you on what’s likely causing the discomfort, and point you to the exact sections in the course that are most relevant for your situation.

This combination of self-paced learning and guided expert support is changing lives for families every single day.

Click here to explore the Reflux-Free Framework and get started today.

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