Medications that decrease acidity in the stomach do not improve infants’ crying or spitting up. These symptoms are common and usually improve on their own, as the child grows up. Studies show that infants who take medications that block stomach acid secretion have more respiratory and gastrointestinal infections. Motility agents do not improve symptoms of reflux in infants but they can have side effects on the heart and nervous system, as well as dangerous interactions with other medications. For example, domperidone can increase the QTc interval on the EKG, particularly when used with other medications that affect liver metabolism, and metaclopromide can cause tardive dyskinesia. Infants with gastroeosophageal reflux and poor growth, who have recurrent respiratory problems or who bleed from their gastrointestinal tract, need further evaluation and may need medication. However, most infants will not need them.
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Tighe M, et al. Pharmacological treatment of children with gastro-oesophageal reflux. Cochrane Database Syst Rev. 2014 Nov 24;(11):CD008550. PMID: 25419906.
Vandenplas Y, et al. Pediatric gastroesophageal reflux clinical practice guidelines: joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). J Pediatr Gastroenterol Nutr. 2009 Oct;49(4):498-547. PMID: 19745761.
van der Pol RJ, et al. Efficacy of proton-pump inhibitors in children with gastroesophageal reflux disease: a systematic review. Pediatrics. 2011 May;127(5):925-35. PMID: 21464183.