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In children with reflux symptoms, conservative treatment is very often effective. Reflux in infants is very common and the problem usually settles down by the year one.

There are, however, a few children where symptoms persists. If this is associated with failure to thrive, weight loss, restlessness, crying, poor feeding pattern, or anaemia, then intervention is necessary.

Opinion vary as to whether investigations should precede drug treatment or carried out if drug treatment fails. Investigations include endoscopy and biopsy, and 24 hour pH monitoring. Either way medication to treat acid reflux is warranted. The likelihood is that the child has esophagitis.

Although not as effective as the newer proton pump inhibitors such as omeprazole, ranitidine still remains an effective acid reflux treatment in children with GERD.

Seventy percent of children with esophagitis will respond to an eight week course of high dose ranitidine. A high dose is 4mg/Kg body weight per dose twice to three times a day.

The grade of esophagitis has significant effect on the cure rate. In children with Grade 1 esophagitis at onset of treatment, 90% is expected to improve but in grade 3 and 4 expect 43%.

With side effects of these drugs so rare and a high healing rate, ranitidine is a very good acid reflux treatment in children.

Dr. Phil Hariram.